DecisionKEYS: a shared decision-making aid

Overview

DecisionKEYS is a nurse-facilitated, smartphone-based decision aid designed to support patients with early-stage breast cancer as they navigate complex surgical and reconstruction choices. Grounded in the Janis and Mann Conflict Theory of Decision Making, the decision aid first helps patients clarify their personal values and preferences before guiding them through a structured exercise that examines the potential gains and losses of each option.

By making tradeoffs explicit and personally meaningful, the guide aims to reduce decisional conflict, support informed, shared decision making with the clinical team, and ultimately decrease future decisional regret.

What the MAP Lab team is doing

• Decision-aid architecture — structuring content around the balance-sheet framework so patients can compare options on the dimensions that matter to them.
• Values-clarification module — interactive exercises that surface patient priorities (recurrence risk, recovery, appearance, ongoing surveillance) before the surgical consult.
• Clinical workflow fit — designing the aid to slot into the existing UVA Breast Cancer Care Team workflow without adding friction for patients or providers.

Methodology

The guide uses a balance-sheet framework, presenting each option with a parallel structure: what it involves, expected recovery, oncologic equivalence where it applies, cosmetic and reconstructive implications, and surveillance requirements after surgery. The values-clarification exercise then translates abstract trade-offs into concrete preferences — for example, weighing radiation as part of breast-conservation therapy against the longer recovery and surveillance pattern of mastectomy with reconstruction.

Outcomes & current status

The decision guide is in active development with the UVA Breast Cancer Care Team. Once piloted in clinic, the project will assess whether structured SDM and values clarification improve patient-reported decision quality, decisional conflict, and satisfaction with the surgical choice — outcomes that matter for both initial recovery and long-term well-being.