Effect of a Structured Decision Aid on Decisional Conflict and Decision Regret in Breast Cancer Surgery: Experience from Pakistan

Abstract

Objective: The most prevalent cancer among Pakistani women is breast cancer. Even though mastectomy and breast-conserving surgery (BCS) have similar oncologic results in early stages, patient decisions are influenced by socioeconomic status, family involvement, knowledge of health issues, and radiotherapy availability. Decisional conflict and regret are caused by systematic impediments and inadequate consulting time in public-sector hospitals. Although available data indicates that decision aids increase patient participation and satisfaction with the treatment plan, little is known about their utility in low- and middle-income countries (LMICs).

Methods: From April to October 2025, a prospective cohort research was conducted at Mayo Hospital Lahore. A total of 126 women (63 in each group) with stage I–II breast cancer who qualified for either BCS or mastectomy were recruited. Counseling combined with a structured decision aid was compared to regular counseling. The Decisional Conflict Scale (DCS) was used to measure outcomes prior to surgery, and the Decision Regret Scale (DRS) was used six weeks and six months after surgery.

Results: Patients who received the decision assistance exhibited better understanding of available treatments, increased involvement in the decision-making, and lower DCS scores, indicating lesser uncertainty. Additionally, less remorse at both follow-up intervals was reported through lower DRS ratings.

Conclusion: This study demonstrates the efficacy of low-cost decision aids in LMICs such as Pakistan. Decision aids reduce decisional conflict and regret in breast cancer surgery by overcoming challenges such low literacy, limited consultation time, and family dominance by simplifying complex knowledge and by clarifying patient values

Keywords: Decision making, Decision aids, Patient Participation, Patient Satisfaction