The research team, led by Monica Adams of the University of Houston and Sarah E. Tevis of the University of Colorado Anschutz Medical Campus, built the IDECIDE Breast Surgery patient decision aid around a simple but powerful premise: quality of life should not be an afterthought evaluated only once the surgeon’s schedule is booked. Previous studies have shown that patients are remarkably poor at predicting their own future well-being after breast surgery. Work published in JAMA Surgery and the Annals of Surgical Oncology demonstrated that women frequently misjudge how they will feel about reconstruction, body image, and disease-related stigma years down the line, a psychological phenomenon known as affective forecasting error. By embedding patient-reported outcome data into the deliberation process itself, IDECIDE tries to replace guesswork with evidence before the decision is locked in.

The development process followed two of the most rigorous frameworks in the field. The team anchored the tool’s structure in the Ottawa Decision Support Framework, a widely used model that identifies what patients need to make health decisions: clear options, balanced benefits and harms, and attention to the values that guide personal choice. They then benchmarked the tool against the International Patient Decision Aids Standards, or IPDAS, a consensus-based quality criteria framework developed through an international Delphi process and regarded as the gold standard for decision aid design. Meeting IPDAS criteria requires more than accurate information; it demands balanced presentation, disclosure of uncertainty, and explicit support for communicating with clinicians, which is precisely where many freely available online resources about breast surgery fall short.

What distinguishes IDECIDE from earlier breast cancer decision aids is its data source. Rather than relying on generic statistics from the published literature, the tool integrates patient-reported quality-of-life outcomes collected at the institution where the patient is actually being treated. This means a woman considering her options sees how patients at her own center, operated on by the same surgical teams, have reported their well-being over time. The approach reflects a growing recognition in oncology that survivorship outcomes, not just survival curves, are what patients care about most, and that local data may feel more credible and relevant than national averages drawn from populations that may not resemble the patient in the exam room.

To test whether the tool actually worked, the researchers conducted iterative evaluations with the people who matter most: patients and clinicians. Nine patients and six clinicians assessed the decision aid through structured surveys and semi-structured interviews, with transcripts analyzed using a rapid thematic coding approach, a qualitative method designed to deliver valid findings quickly enough to inform iterative refinement. The quantitative results were striking. Patients rated the tool’s understandability at 98.7 percent and its actionability, meaning how well it tells readers what they can do next, at 92.0 percent. Every single patient found the length and amount of information appropriate, a rare feat in a field where medical materials are routinely criticized as either overwhelming or superficial.

Clinicians were equally enthusiastic. The six clinicians, spanning the multidisciplinary team that breast cancer care requires, rated understandability at a perfect 100 percent and actionability at 95.2 percent. Both groups independently judged the tool to be balanced in how it presented the surgical options, which is a critical IPDAS benchmark, since even subtle framing can push patients toward one operation or another. On formal IPDAS criteria scoring, clinicians gave the tool 42.5 out of a possible 46.0 points, placing it among the higher-performing decision aids evaluated against that standard. The measurement instruments themselves were validated tools, including the Patient Education Materials Assessment Tool, known as PEMAT, which was developed specifically to quantify how understandable and actionable patient-facing health materials are.

The qualitative interviews added texture to the numbers. Patients singled out the clarity of the writing, the usefulness of the visual aids, and, above all, the inclusion of quality-of-life data as the tool’s greatest strengths. They also offered concrete suggestions: additional content in certain areas and improved formatting. Clinicians, drawing on their experience counseling hundreds of patients, recommended expanding the tool to address decisions about contralateral breast surgery, the question of whether to operate on the healthy breast, and concerns related to endocrine therapy, the hormone-blocking treatment that many breast cancer patients take for years after surgery. These critiques are not failures of the tool but rather the raw material of iterative design, and the research team plans to incorporate them before the next phase of testing.

The stakes of getting this right are higher than they might appear. Research on decision regret in breast cancer has shown that a meaningful fraction of women experience regret about their surgical choice, and that this regret can persist over time rather than fade. Shared decision-making, in which patients and clinicians collaborate as informed partners, has been proposed as the antidote, and Cochrane systematic reviews have found that decision aids reliably improve knowledge, reduce decisional conflict, and increase the proportion of choices that align with patient values. Yet international surveys have documented that shared decision-making remains inconsistently implemented in breast cancer care, and systematic reviews of existing breast surgery decision aids have identified gaps in both quality and the integration of long-term outcome data. IDECIDE is designed to close exactly those gaps.

The technical architecture of the evaluation also deserves attention. Interviews were conducted and transcribed using modern digital tools, and the qualitative analysis employed a team-based open coding approach aimed at achieving intercoder consensus, a methodological safeguard that reduces the risk of a single analyst’s bias shaping the findings. The mixed-methods design, integrating quantitative survey scores with qualitative interview themes, follows established principles for achieving genuine integration across data types rather than simply reporting them side by side. The study received approval from the Colorado Multiple Institutional Review Board, and all participants provided informed consent, with the underlying datasets protected under human subjects restrictions.

What comes next will determine whether IDECIDE remains a promising prototype or becomes a standard part of breast cancer care. The research team plans to implement the revisions suggested by patients and clinicians and then pilot the refined tool with newly diagnosed breast cancer patients, the population for whom the stakes are highest. If those pilots confirm the early results, the model of embedding institution-specific, patient-reported quality-of-life data into surgical decision aids could extend well beyond breast surgery, offering a template for any decision where equivalent treatments lead to meaningfully different lives afterward. For the roughly one in eight women who will face a breast cancer diagnosis, the promise is simple: a decision made not in the dark, but with the clearest possible picture of the road ahead.

Subject of Research: Development and evaluation of a quality-of-life-integrated patient decision aid for early-stage breast cancer surgery

Article Title: IDECIDE breast surgery patient decision aid: Development and testing of a quality of life-integrated decision support tool

Article References: Adams, M., Durden, J. A., Leslie, S. E., Vemuru, S. R., Higgins, M. G., Matlock, D. D., Baimas-George, M., Daly, R., Lee, C., Colborn, K., Fisher, C. M., Christian, N. T., Kaoutzanis, C., Egan, K., & Tevis, S. E. (2026). IDECIDE breast surgery patient decision aid: Development and testing of a quality of life-integrated decision support tool. Supportive Care in Cancer, 34(10), Article 955. https://doi.org/10.1007/s00520-026-11199-4

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11199-4

Keywords: breast cancer, patient decision aid, shared decision-making, quality of life, breast-conserving surgery, mastectomy, patient-reported outcomes, Ottawa Decision Support Framework, IPDAS, decision regret, patient-centered care, supportive care in cancer