A decision aid has been developed for follow-up care in breast cancer patients using healthcare outcomes to support the healthcare provider and patient in the collective decision-making process. Research will be conducted in the coming period into the effects of implementation of the decision aid.
With the Breast cancer follow-up care decision aid, the decisions surrounding follow-up care are supported as the healthcare provider calculates the personal risk of recurrent breast cancer using the INFLUENCE nomogram, a prediction method developed by the University of Twente based on a wide set of outcome data provided by the Netherlands Cancer Registration.
Yvonne van Riet, breast cancer surgeon at the Catharina Hospital in Eindhoven: “With the decision aid, we prepare a personal calculation for each patient to identify the risk of recurrence of cancer in the breast. It is designed to help make women aware of how low the risk often is and to include that awareness in the shared decision concerning the frequency of follow-up exams.” The Breast cancer follow-up care decision aid was made possible in part by intensive collaboration with the Dutch Breast Cancer Association (Borstkankervereniging Nederland). The decision aid also takes the level of a patient’s fear of recurrence into consideration. This facilitates open discussion of fear during consultations and ensures that appropriate support can also be provided.
Healthcare outcomes are clinical results of healthcare, such as data concerning treatment outcomes, disease recurrence, as well as the impact on a patient’s quality of life. The Breast cancer decision aid was developed as a component of Santeon’s Outcome Indicators Experiment. The Experiment is supported by the Ministry of Health, Welfare and Sport within the framework of the Outcome-based Healthcare Programme. The objective of the Experiment is to make outcome-based information accessible in the clinic or consultation room. Patients receive personalised information about healthcare outcomes so that - together with their healthcare provider - they can better decide which healthcare is best for their personal situation.
In addition to the Breast cancer decision aid, a decision aid was also developed for CVA and kidney failure based on healthcare outcomes. The decision aids were developed in collaboration with patient associations, scientific associations and the ZorgKeuzeLab, and align with the existing healthcare strategies. Together with the Netherlands Comprehensive Cancer Organisation (IKNL), the University of Twente is also continuing the development of the INFLUENCE nomogram based on data from the Netherlands Cancer Registry.
In the coming period during the Outcome Indicators Experiment, further research will be conducted into the effects of implementing the decision aids. Healthcare providers from other healthcare institutions interested in using the decision aids can contact the Zorgkeuzelab.
- INFLUENCE nomogram: Personalisation of breast cancer follow-up: a time-dependent prognostic nomogram for the estimation of annual risk of locoregional recurrence in early breast cancer patients. Witteveen A, Vliegen IM, Sonke GS, Klaase JM, IJzerman MJ, Siesling S.Breast Cancer Res Treat. 2015 Aug;152(3):627-36. doi: 10.1007/s10549-015-3490-4. Epub 2015 Jul 11.PMID: 26162567
- The decision aids are available via www.experiment-uitkomstindicatoren.nl or op www.zorgkeuzelab.nl (Dutch only).