International Journal of Technology Assessment in Health Care


Health technology assessment–based development of a Spanish breast cancer patient decision aid

Fátima Izquierdoa1, Javier Graciaa1, Mercedes Guerraa1, Juan Antonio Blascoa1 and Elena Andradasa1

a1 Agencia Laín Entralgo


Objectives: The aim of this study was to develop a breast cancer Patient Decision Aid (PDA), using a Health Technology Assessment (HTA) process, to assist patients in their choice of therapeutic options, and to promote shared decision making among patients, healthcare professionals, and other interested parties.

Methods: A systematic review (SR) was conducted of existing breast cancer patient Decision Aids encountered in the main scientific journal databases and on institutional Web sites that create PDAs, together with a Qualitative Research (QR) study, using semi-structured interviews and focus group with stakeholders (patients, family members, and health professionals), with the aim of developing a PDA for breast cancer.

Results: The SR shows that PDAs in breast cancer not only increase patient knowledge of the illness, leading to more realistic expectations of treatment outcomes, but also reduce passivity in the decision-making process and facilitate the appropriate choice of treatment options in accordance with patient medical and personal preferences. The analysis of QR shows that both breast cancer patients and healthcare professionals agree that surgery, adjuvant treatments, and breast reconstruction represent the most important decisions to be made. Worry, anxiety, optimism, and trust in healthcare professionals were determined as factors that most affected patients subjective experiences of the illness. This HTA was used as the basis for developing a PDA software program.

Conclusions: The SR and QR used in the development of this PDA for breast cancer allowed patients to access information, gain additional knowledge of their illness, make shared treatment decisions, and gave healthcare professionals a deeper insight into patient experiences of the disease.

(Online publication October 07 2011)


The authors thank Ms. Petra Díaz del Campo Fontecha for her participation and collaboration during the qualitative research segment and Ms. María Soriano Cirugeda and Ms. Raquel Luengo González for their methodological contributions and comments, which contributed to the improvement of the PDA. We would also like to thank Mr. Ladislao Bapory for his comments and help with the English version of this study.

Source of Funding: This project was partially financed by the Spanish Quality Plan for the National Health System overseen by the Ministry of Health and Social Policy.