将 BREASTChoice 决策工具应用到电子健康记录中并评估其有效性。BREASTChoice 是一种多级决策工具，可以： 1) 对患者进行乳房重建教育； 2）估计并发症的个性化风险； 3）明确患者的偏好； 4) 告知临床医生患者的风险和偏好。一项多中心随机对照试验招募了患有 0-III 期乳腺恶性肿瘤并接受乳房切除术的成年女性。参与者被随机分配到 BREASTChoice 或对照网站。一项调查评估了知识、偏好、决策冲突、共同决策、首选治疗和可用性。我们进行了意向治疗 (ITT)、符合方案 (PP) 分析（那些随机分配到使用该工具的 BREASTChoice 的分析）和分层分析。23/25 名合格的临床医生入组。 369/761 (48%) 联系了登记的患者并进行了随机分组。患者的平均年龄为51岁； 15% 的年龄超过 65 岁。BREASTChoice 参与者比对照参与者拥有更高的知识（ITT：平均 70.6 vs. 67.4，P=0.08；PP：平均 71.4 vs. 67.4，P=0.03），特别是按地点分层时（ITT：P =0.04，PP：P=0.01）、年龄（ITT：P=0.04，PP：P=0.02）和种族（ITT：P=0.04，PP：P=0.01）。 BREASTChoice 并没有改善决策冲突、偏好与治疗之间的匹配或共同决策。在 PP 分析中，使用 BREASTChoice 的高危患者较少选择重建。 BREASTChoice 具有很高的可用性。BREASTChoice 是一种新颖的决策工具，集风险预测、患者教育和临床医生参与于一体。使用BREASTChoice的患者知识水平较高；老年人和来自少数种族背景的人尤其受益。对其他决策结果没有影响。未来的研究应克服实施障碍，并专门检查高风险患者的决策结果。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

To implement the BREASTChoice decision tool into the electronic health record and evaluate its effectiveness.BREASTChoice, is a multilevel decision tool that: 1) educates patients about breast reconstruction; 2) estimates personalized risk of complications; 3) clarifies patient preferences; and 4) informs clinicians about patients' risk and preferences.A multisite randomized controlled trial enrolled adult women with stage 0-III breast malignancy undergoing mastectomy. Participants were randomized to BREASTChoice or a control website. A survey assessed knowledge, preferences, decisional conflict, shared decision-making, preferred treatment, and usability. We conducted intent-to-treat (ITT), per-protocol (PP) analyses (those randomized to BREASTChoice who accessed the tool), and stratified analyses.23/25 eligible clinicians enrolled. 369/761 (48%) contacted patients enrolled and were randomized. Patients' average age was 51 years; 15% were older than 65. BREASTChoice participants had higher knowledge than control participants (ITT: mean 70.6 vs. 67.4, P=0.08; PP: mean 71.4 vs. 67.4, P=0.03), especially when stratified by site (ITT: P=0.04, PP: P=0.01), age (ITT: P=0.04, PP: P=0.02), and race (ITT: P=0.04, PP: P=0.01). BREASTChoice did not improve decisional conflict, match between preferences and treatment, or shared decision-making. In PP analyses, fewer high-risk patients using BREASTChoice chose reconstruction. BREASTChoice had high usability.BREASTChoice is a novel decision tool incorporating risk prediction, patient education, and clinician engagement. Patients using BREASTChoice had higher knowledge; older adults and those from racially minoritized backgrounds especially benefitted. There was no impact on other decision outcomes. Future studies should overcome implementation barriers and specifically examine decision outcomes among high-risk patients.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.