Developing a decision aid for women considering Port-Treatment CA-125 testing for ovarian cancer
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Aims: This thesis had three aims: to review evidence evaluating the effectiveness of decision aids at increasing cancer patients’ treatment-related knowledge and reducing decisional conflict; to explore the decision-making processes of ovarian cancer patients who had opted for or against CA-125 testing during post-treatment surveillance; and to elicit patients’ and health professionals’ views on the proposed development of a decision aid aimed at helping women decide for or against CA-125 testing during post-treatment surveillance for ovarian cancer. Methods: A systematic review was conducted of evidence relating to the effectiveness of cancer treatment-related decision aids at increasing treatment-related knowledge and reducing decisional conflict. In the qualitative study, semi-structured interviews were conducted with ovarian cancer patients (n = 18) and health professionals (n = 6) in an outpatient gynecological oncology clinic. Framework analysis was used to identify themes in the qualitative data. Results: Overall, results from the systematic review supported previous research where decision aids were found to improve patient knowledge and reduce decisional conflict across a range of cancer treatment-related decisions. However, the lack of psychometric support for the treatment-related knowledge measures used in the majority of the studies compromised their ability to address the review question. In the qualitative study, accurate knowledge about CA-125 testing in post-treatment surveillance was found to greatly influence participants’ decision-making processes. Most women with less knowledge about the test chose to have testing based on the false belief that earlier detection of recurrence would lead to earlier treatment and prolonged survival. There was strong enthusiasm from patients and health professionals for the development of the proposed decision aid to assist women facing this treatment decision. Conclusions: The systematic review findings add to previous research supporting the use of decision aids in cancer-related treatment decisions and advocate for their continued development, evaluation and implementation into the healthcare system. The need for a decision aid to ensure accurate knowledge about CA-125 and to aid decision-making for women with ovarian cancer was supported. As well as assisting women with this decision, the proposed decision aid may ultimately support health professionals in practicing shared decision-making regarding CA-125 testing with ovarian cancer patients.