Discussion
To our knowledge, this randomized clinical trial represents the first report of the use of a decision aid to choose between breast-conserving surgery and mastectomy in the Indian population, using a self-administered, multilingual, online, interactive decision tool based on adaptive conjoint analysis to assess patient preference. We found a significant improvement in DCS score through the use of the Navya-PPT. Similar findings were reported in a randomized clinical trial from Canada with improvement of DCS score (1.40 vs 1.62; difference, 0.22; SE, 0.10; Further, the median age of women in our study was 48 years and 55% were premenopausal or perimenopausal, representing a younger population, consistent with the country’s population pyramid.We believe the reduction of DCS score in the intervention groups and the increased match of preference with final surgery type were a result of fewer patients being unsure of their choice after using the decision aid. In lower middle-income countries such as India, decisions between breast-conserving surgery and mastectomy are often determined paternalistically,Another unique feature of our study was the inclusion of additional psychological indices, such as API-DM, TEGR, and caregiver role scales. Women who are less autonomous, more traditional, and more responsible for caregiving functions in the family likely have inherent disparities in access to shared decision-making. We show that the use of Navya-PPT can reduce DCS score in women regardless of decreased autonomy, adherence to more traditional gender norms, or higher caregiving burden. This bodes favorably for engaging women in shared decision-making with an appropriately designed decision aid.