DISCUSSION
tumor, breast cancer
TUMOR, BREAST CANCER, AIDS, DISEASE, DISEASE CHARACTERISTIC
In this study, approximately half of recently diagnosed, Latin American breast cancer patients were able to correctly identify their disease stage or molecular subtype. Furthermore, only one third of participants identified which systemic treatments were recommended according to their individual tumor characteristics. These findings underscore the need to improve information provision and promote breast cancer patient education. In the research protocol, a customizable brochure was hypothesized to result in improved identification of molecular subtype by encouraging a dialog between patients and their treating physicians when identifying the options applicable to each case. However, no statistical differences were observed in patient knowledge about their molecular subtype or clinical stage at diagnosis according to the type of educational brochure received. Therefore, the hypothesis that the proportion of patients who would identify their molecular subtype with the customizable brochure would be 20% greater than the standard group was not met. Notably, patients allocated to the customizable brochure were significantly more likely to identify which systemic therapy they should receive according to their disease characteristics and perceived a stronger agreement that the brochure helped them participate in treatment decisions. This suggests that personalizing written materials was an effective tactic to enhance their educational value, possibly by stimulating shared‐decision making between patients and their treating physicians.Previous studies have demonstrated that patient education interventions can enhance breast cancer patients' knowledge and comprehension. Buscemi et al. developed a culturally tailored smartphone application for Hispanic patients and found that its use was associated with a significant improvement in general breast cancer knowledge in this population.Patient knowledge regarding individual characteristics of their breast cancer can improve their understanding on recommended treatment strategies (e.g., hormone therapy in cases of hormone‐sensitive disease or trastuzumab in cases with HER2 amplification), which can lead to guideline‐endorsed treatment decisions and greater therapeutic adherence.This study has limitations to consider when interpreting the results. First, the study is underpowered to detect subtle differences according to the type of brochure received. Second, no multiple comparison correction was undertaken. Third, the sample studied is not representative of all Latin America and the results cannot be generalized. Fourth, because of the nature of the intervention, blinding of participants and treating physicians was not possible. Fifth, clinicians at participating centers were aware that patient knowledge was being assessed and it is possible that they might have been more inclined to emphasize disease characteristics. Sixth, due to participant attrition and nonresponse throughout the protocol, nonresponder bias cannot be excluded. Seventh, improvement in knowledge about their disease directly after receiving each of the brochures was not assessed as no pre‐intervention questionnaires were applied. Eight, patients assigned to the customizable educational brochure were encouraged to personalize their material with the assistance of healthcare providers, but mandatory discussion of brochures with the treating physicians was not enforced. Hence, patients assigned to customizable brochures might not have filled out the material or might have done so incorrectly if they did not discuss the contents with a physician, potentially underestimating the true utility of this type of written educational material.Although patients were not involved in the development of the content of the educational material, they were interviewed to identify whether the vocabulary employed in the brochures was comprehensible and to evaluate the general perception of its utility. Their feedback and comments were incorporated into the final version of the brochure. Noteworthy, the purpose of this project was not to propose this brochure as a standard to be widely used, but to demonstrate that a customizable, educational material aids patients. The results are in line with this objective and affirm the usefulness of providing customizable, educational materials to patients.