PROBLEM IDENTIFICATION:The use of a decision aid (DA) for women facing the decision of contralateral prophylactic mastectomy (CPM) is limited. This article aimed to examine the literature for studies testing a DA for patients diagnosed with unilateral breast cancer considering CPM. LITERATURE SEARCH:A comprehensive search was conducted in CINAHL®, Ovid MEDLINE®, PubMed®, Web of Science, PsycINFO®, and Cochrane Library databases from 2017 to 2024. DATA EVALUATION:The studies were assessed for relevance in testing a patient DA for CPM in patients diagnosed with unilateral breast cancer. Studies were evaluated using the Mixed Methods Appraisal Tool, version 2018. SYNTHESIS:Five studies met inclusion criteria. These studies included one pre-/postassessment cohort pilot study, one randomized controlled trial, two mixed-methods studies, and one qualitative study. Studies included 370 patients and 50 clinicians in the breast oncology setting. IMPLICATIONS FOR PRACTICE:Oncology nurses can play a key role in advocating for shared decision-making for patients considering CPM. Additional testing of a DA for patients diagnosed with unilateral breast cancer considering CPM should be considered.

Introduction In 2016, an American Society of Breast Surgeons (ASBrS) statement discouraged contralateral prophylactic mastectomy (CPM) in average-risk women with unilateral breast cancer. Despite evidence of no oncologic benefit and related attempts to discourage the practice, CPM remains prevalent. This study aims to assess CPM trends post-ASBrS statement and factors associated with these trends. Methods A retrospective cohort study of patients with primary unilateral breast cancer undergoing complete mastectomy at a single-tertiary center between January 2014 and December 2020 was performed. We assessed the proportion opting for CPM, compared pre- and post-ASBrS statement CPM rates, and examined associated patient and tumor factors. Pearson's Chi-square test, Fisher's exact test, and equal variance t-tests were used to compare subsets who underwent CPM versus those who did not. Results Of 605 patients, 161 (27%) underwent CPM during our study period, with the median follow-up time for all patients being 58 mo (IQR: 38 to 81). Among all patients, CPM rates ranged from 30% to 14% before the ASBrS statement and then declined from 36% to 19% after the statement. For average-risk patients (no genetic mutation), these rates ranged from 20.2% to 10.2% from 2014 to 2016 and had a steady decline from 23.2% in 2017 to 13.2% in 2020. Only two cases (1.2%) had incidental contralateral breast cancer. Patients undergoing CPM tended to be younger, more likely to have a breast cancer gene mutation, pursue reconstruction, and elect for nipple- or skin-sparing mastectomy. Recurrence and mortality events did not differ significantly. Genetic testing and pathogenic variant rates were greater among CPM patients. Conclusions After an initial time lag, CPM rates appear to be decreasing post-ASBrS statement, with ongoing data needed to confirm this trend. CPM rates among breast cancer gene patients align appropriately with guidelines catering to this higher risk population. Better educational tools and decision aids may impact CPM trends and facilitate shared decision-making.

Innovative ways of screening for cognitive decline are urgently needed to increase detection and access to early treatment, particularly for those at highest risk for morbidity and mortality. The aim of this scoping review was to identify how cognitive screening is conducted within primary care and other clinical settings, specifically focusing on the use of lay navigators. Using Arksey and O’Malley’s framework for scoping reviews, inclusive of collaborators’ feedback, we included English-language research articles published after 2010 and identified ten articles. We found that lay navigators could effectively screen for common memory problems, provide support to patients and caregivers’ needs, and deliver standardized education. Incorporating cognitive screening by lay navigators can facilitate earlier access to effective treatment, especially by those burdened by existing disparities. Future research and widespread adoption of these innovative methods may improve earlier screening and thus early detection and treatment in primary care settings.

Background: Pediatric clinical trials are particularly vulnerable to challenges in participant accrual, making them more likely to encounter early termination. Objective: To describe clinical trial characteristics of phase 1 pediatric oncology clinical trials registered in ClinicalTrials.gov through 2017. Method: We identified a retrospective cohort and abstracted key clinical trial characteristics from this data source. We calculated a bivariate logistic regression to explore factors related to early trial termination. Results: Over 1400 phase 1 trials were included in this analysis. Only 3.2% of trials included any type of patient-reported outcome (PRO) as a secondary outcome and 21.6% of phase 1 trials did not meet scientific success due to early termination. National Institutes of Health (NIH)-funded phase 1 trials had the lowest percentage of early termination. Conclusions: Phase 1 clinical trials for pediatric patients with cancer are at risk of early termination due to lack of enrollment. A deeper understanding of clinical trial design elements, characteristics, and eligibility determination may contribute to a higher proportion of trials meeting successful enrollment. Implications for Practice: Oncology nurses and nurse scientists uniquely contribute to an understanding of family-centered approaches and should take an active role in trial design for pediatric cancers that could help capture meaningful PROs during a vulnerable clinical trajectory. What Is Foundational: Very little attention has been given to understanding characteristics of phase 1 clinical trials for pediatric cancers that may impact the state of the science and care delivery for patients with advanced pediatric cancer diagnoses.

PURPOSE:To determine the feasibility and acceptability of using a patient decision aid (DA) for women with elevated breast cancer risk who are considering MRI screening.METHODS:This pilot study employed a mixed methods design to develop, modify, and test an interactive DA. The DA was administered among a consecutive patient sample with an estimated Tyrer-Cuzick v.8 lifetime breast cancer risk of 20% or greater and without a pathologic genetic mutation. The decisional conflict scale was used to measure decisional conflict. Post-intervention provider and patient feedback evaluated shared decision-making, feasibility, and acceptability.RESULTS:Twenty-four patients participated, with a median age of 44 years. Prior to DA use, sixteen patients (67%) were unsure whether to add MRI to their screening, six patients elected MRI (25%), and two patients declined MRI (8%). Following DA use, thirteen of sixteen of the initially undecided participants (81%) established a preference, with eleven electing to add MRI screening. Of participants with an initial preference, all maintained the same decision following use of the DA. Prior to the DA, the median decisional conflict score among participants was 25% (range 0-60%) compared with 0% (range 0-25%) after the DA. Healthcare providers reported that the DA was useful and easily incorporated into clinical workflow.CONCLUSIONS:This pilot study shows that there may be a benefit to DA utilization in the high-risk breast cancer clinic to guide shared decision-making in establishing a screening preference. The findings warrant further research to test the use of the DA in a larger, multi-site trial.

OBJECTIVES To determine the feasibility and acceptability of using a decision aid (DA) in a breast surgery clinic. SAMPLE & SETTING 42 patients with minimally suspicious mammograms and two physicians participated in this study at an outpatient breast specialty clinic in Virginia. METHODS & VARIABLES A quasiexperimental single group pilot study was conducted to determine the feasibility of DecisionKEYS, a theory-based, interactive DA intervention. Patients with minimally suspicious mammogram results chose between breast biopsy or close imaging follow-up. The Decisional Conflict Scale was used to measure decisional conflict. The Decision-Making Quality Scale was used to evaluate the overall decision process. Postintervention physician and patient feedback evaluated feasibility and acceptability. RESULTS Participants and physicians rated the DA as helpful. Decisional Conflict Scale scores were low before and after the intervention. Physicians reported the DA was feasible for workflow, and the majority reported using the DA in making final recommendations. Management recommendation (breast biopsy, close imaging follow-up) changed in 26 of 42 cases from pre- to postintervention. The majority of participants underwent breast biopsy. IMPLICATIONS FOR NURSING The feasibility and acceptability of the DA were beneficial to patients and clinic workflow.

Background Metastatic prostate cancer remains a lethal malignancy that warrants novel supportive interventions for patients and their decision partners and proxies. Decision aids have been applied primarily to patients with localized disease, with minimal inclusion of patients with advanced prostate cancer and their decision partners. The use of a community patient navigator (CPN) has been shown to have a positive supportive role in health care, particularly with individuals from minority populations. Research is needed to evaluate decision support interventions tailored to the needs of advanced prostate cancer patients and their decision partners in diverse populations. Methods Guided by Janis and Mann’s Conflict Model of Decision Making, the Cancer Health Aid to Manage Preferences and Improve Outcomes through Navigation (CHAMPION) is a randomized controlled trial to assess the feasibility and acceptability of a mobile health (mHealth), CPN-administered decision support intervention designed to facilitate communication between patients, their decision partners, and the healthcare team. Adult prostate cancer patients and their decision partners at three mid-Atlantic hospitals in the USA were randomized to receive enhanced usual care or the decision intervention. The CHAMPION intervention includes a theory-based decision-making process tutorial, immediate and health-related quality of life graphical summaries over time (using mHealth), values clarification via a balance sheet procedure with the CPN support during difficult decisions, and facilitated discussions with providers to enhance informed, shared decision-making. Discussion The CHAMPION intervention is designed to leverage dynamic resources, such as CPN teams, mHealth technology, and theory-based information, to support decision-making for advanced prostate cancer patients and their decision partners. This intervention is intended to engage decision partners in addition to patients and represents a novel, sustainable, and scalable way to build on individual and community strengths. Patients from minority populations, in particular, may face unique challenges during clinical communication. CHAMPION emphasizes the inclusion of decision partners and CPNs as facilitators to help address these barriers to care. Thus, the CHAMPION intervention has the potential to positively impact patient and decision partner well-being by reducing decisional conflict and decision regret related to complex, treatment-based decisions, and to reduce cancer health disparities. Trial registration ClinicalTrials.gov NCT03327103 . Registered on 31 October 2017—retrospectively registered. World Health Organization Trial Registration Data Set included in Supplementary Materials.