Abstract A41: A Web-based decision aid for low health literacy women making breast cancer surgery decisions

Providing decision support to patients with low health literacy is a challenging and under-researched area. With funding from the U.S. Army Medical Research and Materiel Command, we developed and evaluated a computerized patient decision aid to assist women with early stage breast cancer in making a surgical treatment decision. The decision aid incorporates entertainment-education (edutainment) with enhanced (factual) content. This project was designed to educate low health literate women and novice computer users. An interactive jewelry box is featured to assist women in recording and reflecting over issues of concern with possible treatments; deliberating over surgery decision; and communicating with physician and significant others. Findings from the study indicated that women who received usual care plus the patient decision aid made more informed treatment decisions than women who only received usual care. Women who viewed the patient decision aid found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment. Despite these favorable results, after some years the content was outdated, the application did not run in newer computer systems, and some usability and functionality features of the application needed updating. Recently, the Susan G. Komen for the Cure provided us with funding to update, package and disseminate the software to national audiences. To accomplish the update, the original reference document created for development of the decision aid was redesigned and improved. This document9s content was reviewed and updated by a content expert panel. Concurrently with the review of the content, usability testing of the existing decision aid was conducted with novice computer users to evaluate and improve the usability of the program. Based on findings from the usability testing, significant modifications were made to the user interface and functionality. In addition, the architecture of the decision aid was converted to an open-architecture that permits efficient content management, deployment, and updating. After completion of the update, usability testing of the application was conducted with novice computer users. The usability testing results were uniformly positive, indicating a very high level of user satisfaction. The updated decision aid has been installed in a dedicated public web site hosted by the Dan L. Duncan Cancer Center (www.bcm.edu/patchworkoflife). A CD-ROM version of the application can also be accessed at this site. The application is currently being accessed by breast cancer patients at two public hospitals in a large urban area. Regional and national dissemination plans are being developed to promote distribution of this patient decision-making tool.