Decision aids for localized prostate cancer in diverse minority men: Primary outcome results from a multicenter cancer care delivery trial (Alliance A191402CD)

Cancer ◽  
2021 ◽  
Author(s):  
Jon C. Tilburt ◽  
David Zahrieh ◽  
Joel E. Pacyna ◽  
Daniel G. Petereit ◽  
Judith S. Kaur ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Care ◽  
Primary Outcome ◽  
Care Delivery ◽  
Decision Aids ◽  
Localized Prostate Cancer ◽  
Minority Men

Lessons learned from implementing the first Alliance NCORP Research Base Cancer Care Delivery Research (CCDR) trial A191402CD.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 175-175
Author(s):  
Joel E Pacyna ◽  
Jeff A. Sloan ◽  
Simon P. Kim ◽  
Hillary Sedlacek ◽  
Jon Charles Tilburt
Keyword(s):  
Clinical Trials ◽  
Cancer Care ◽  
Early Stage ◽  
Care Delivery ◽  
Decision Aids ◽  
Symptom Control ◽  
Cluster Randomized Trial ◽  
Lessons Learned ◽  
Oncology Research ◽  
Minority Men

175 Background: Biomedical research focused on the experiences of cancer patients in care delivery has progressed remarkably in recent years, including the emergence of Cancer Care Delivery Research (CCDR) within the NCI Community Oncology Research Program (NCORP). CCDR is a relatively new mechanism with the NCORP to support protocols that test questions beyond standard clinical trials for treatment or symptom control interventions. CCDR leverages the NCORP infrastructure to develop and test care delivery interventions in community hospital settings and in settings serving underserved and minority populations. CCDR enables researchers to conduct care delivery studies in critical places and in niche populations. Methods: We will describe our experience coordinating the first Alliance NCORP Research Base Cancer CCDR trial. Our trial – a four arm, cluster-randomized trial of decision aids among sites capable of oversampling minority men with a diagnosis of early stage prostate cancer – was the first CCDR trial in the Alliance NCORP Research Base. We will describe the opportunities and challenges we encountered. Results: We implemented a CCDR protocol even as the oversight for CCDR was being worked out in parallel. Curating partnerships outside of established channels of clinical trials, engaging minority serving institutions, and engaging surgical practices like urology illustrate some of the challenges of implementing a care-delivery trial in a diverse multi-site network. Research staff must learn the art of mitigating the disruption of care delivery research procedures within clinics. Additionally, the researcher’s skills are drawn upon at multiple points— establishing relationships, advocating for flexibility in implementing rules, cheerleading, connecting dots, and directing traffic. Conclusions: Our “lessons learned” presentation will provide an experiential account that will inform aspiring care delivery researchers in their work and describe some of the emerging aspects of the institutional implementation of new initiatives in modern cooperative group research. Our presentation will also inform key stakeholders about how to best facilitate this type of research.

scholarly journals Introducing Decision Aids into Routine Prostate Cancer Care in The Netherlands: Implementation and Patient Evaluations from the Multi-regional JIPPA Initiative

2019 ◽  
Vol 35 (6) ◽  
pp. 1141-1148
Author(s):  
Maarten Cuypers ◽  
Hoda H. M. Al-Itejawi ◽  
Cornelia F. van Uden-Kraan ◽  
Peep F. M. Stalmeier ◽  
Romy E. D. Lamers ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
The Netherlands ◽  
Cancer Care ◽  
Large Scale ◽  
Decision Aids ◽  
Routine Care ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Daily Routine ◽  
Clinical Routine

AbstractUptake of decision aids (DAs) in daily routine is low, resulting in limited knowledge about successful DA implementation at a large scale. We assessed implementation rates after multi-regional implementation of three different prostate cancer (PCa) treatment DAs and patient-perceived barriers and facilitators to use a DA. Thirty-three hospitals implemented one out of the three DAs in routine care. Implementation rates for each DA were calculated per hospital. After deciding about PCa treatment, patients (n = 1033) completed a survey on pre-formulated barriers and facilitators to use a DA. Overall DA implementation was 40%. For each DA alike, implementation within hospitals varied from incidental (< 10% of eligible patients receiving a DA) to high rates of implementation (> 80%). All three DAs were evaluated positively by patients, although concise and paper DAs yielded higher satisfaction scores compared with an elaborate online DA. Patients were most satisfied when they received the DA within a week after diagnosis. Pre-formulated barriers to DA usage were experienced by less than 10% of the patients, and most patients confirmed the facilitators. Many patients received a DA during treatment counseling, although a wide variation in uptake across hospitals was observed for each DA. Most patients were satisfied with the DA they received. Sustained implementation of DAs in clinical routine requires further encouragement and attention.

scholarly journals Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

2016 ◽  
Vol 34 (18) ◽  
pp. 2182-2190 ◽  
Author(s):  
Ronald C. Chen ◽  
R. Bryan Rumble ◽  
D. Andrew Loblaw ◽  
Antonio Finelli ◽  
Behfar Ehdaie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Clinical Oncology ◽  
Active Surveillance ◽  
Gleason Score ◽  
Cancer Care ◽  
Specific Antigen ◽  
Localized Prostate Cancer ◽  
Risk Category ◽  
American Society

Purpose To endorse Cancer Care Ontario’s guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations. Methods The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommendations. Results The ASCO Endorsement Panel determined that the recommendations from the Active Surveillance for the Management of Localized Prostate Cancer guideline, published in May 2015, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Active Surveillance for the Management of Localized Prostate Cancer guideline with added qualifying statements. The Cancer Care Ontario recommendation regarding 5-alpha reductase inhibitors was not endorsed by the ASCO panel. Recommendations For most patients with low-risk (Gleason score ≤ 6) localized prostate cancer, active surveillance is the recommended disease management strategy. Factors including younger age, prostate cancer volume, patient preference, and ethnicity should be taken into account when making management decisions. Select patients with low-volume, intermediate-risk (Gleason 3 + 4 = 7) prostate cancer may be offered active surveillance. Active surveillance protocols should include prostate-specific antigen testing, digital rectal examinations, and serial prostate biopsies. Ancillary radiologic and genomic tests are investigational but may have a role in patients with discordant clinical and/or pathologic findings. Patients who are reclassified to a higher-risk category (Gleason score ≥ 7) or who have significant increases in tumor volume on subsequent biopsies should be offered active therapy.

scholarly journals Implementation of a decision aid for localized prostate cancer in routine care: A successful implementation strategy

2019 ◽  
Vol 26 (2) ◽  
pp. 1194-1207
Author(s):  
Julia J van Tol-Geerdink ◽  
Inge M van Oort ◽  
Diederik M Somford ◽  
Carl J Wijburg ◽  
Arno Geboers ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Aid ◽  
Implementation Strategy ◽  
Decision Aids ◽  
Routine Care ◽  
Localized Prostate Cancer ◽  
Successful Implementation ◽  
Care Providers ◽  
Implementation Rate ◽  
Patient Decision

For the treatment choice of localized prostate cancer, effective patient decision aids have been developed. The implementation of decision aids in routine care, however, lags behind. Main known barriers are lack of confidence in the tool, lack of training on its use, lack of resources and lack of time. A new implementation strategy addresses these barriers. Using this implementation strategy, the implementation rate of a decision aid was measured in eight hospitals and questionnaires were filled out by 24 care providers and 255 patients. The average implementation rate was 60 per cent (range 31%–100%). Hardly any barriers remained for care providers. Patients who did not use the decision aid appeared to be more unwilling than unable to use the decision aid. By addressing known barriers, that is, informing care providers on the effectiveness of the decision aid, providing instructions on its use, embedding it in the existing workflow and making it available free of charge, a successful implementation of a prostate cancer decision aid was reached.

scholarly journals Development and usability testing of a multi-criteria value clarification methods for patients with localized prostate cancer

2019 ◽  
Vol 26 (1) ◽  
pp. 486-498 ◽  
Author(s):  
Isabel B de Angst ◽  
Marieke GM Weernink ◽  
Paul JM Kil ◽  
Janine A van Til ◽  
Erik B Cornel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Analytic Hierarchy Process ◽  
Decision Aids ◽  
Treatment Decision ◽  
Decision Quality ◽  
Localized Prostate Cancer ◽  
Values Clarification ◽  
Analytic Hierarchy ◽  
Web Based ◽  
Hierarchy Process

Current guidelines for the development of decision aids recommend that they have to include a process for helping patients clarify their personal values, for example, by using values clarification methods. In this article, we extensively described the development process of the web-based values clarification method for patients with localized low- to intermediate-risk prostate cancer based on the analytic hierarchy process. With analytic hierarchy process, the relative importance of different attributes of available treatments can be determined through series of pairwise comparisons of potential outcomes. Furthermore, analytic hierarchy process is able to use this information to present respondents with a quantitative overall treatment score and can therefore give actual treatment advice upon patients’ request. The addition of this values clarification method to an existing web-based treatment decision aid for patients with localized prostate cancer is thought to improve the support offered to patients in their decision-making process and their decision quality.

scholarly journals Decision aids for localized prostate cancer treatment choice: Systematic review and meta-analysis

2015 ◽  
Vol 65 (3) ◽  
pp. 239-251 ◽  
Author(s):  
Philippe D. Violette ◽  
Thomas Agoritsas ◽  
Paul Alexander ◽  
Jarno Riikonen ◽  
Henrikki Santti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Cancer Treatment ◽  
Meta Analysis ◽  
Decision Aids ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
Prostate Cancer Treatment

scholarly journals Lessons in Integrating Shared Decision-Making Into Cancer Care

2018 ◽  
Vol 14 (4) ◽  
pp. 229-235 ◽  
Author(s):  
Karina Dahl Steffensen ◽  
Mette Vinter ◽  
Dorthe Crüger ◽  
Kathrina Dankl ◽  
Angela Coulter ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Care Delivery ◽  
Decision Aids ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Shared Decision ◽  
Care Needs ◽  
Patient Reported

The benefits of shared decision-making (SDM) in health care delivery are well documented, but implementing SDM at the institutional level is challenging, particularly when patients have complex illnesses and care needs, as in cancer. Denmark’s Lillebaelt Hospital, in creating The Patient’s Cancer Hospital in Vejle, has learned key lessons in implementing SDM so that the organization’s culture is actually being transformed. In short, SDM is becoming part of the fabric of care, not a mere add-on to it. Specifically, the hospital chose and structured its leadership to ensure that SDM is constantly championed. It organized multiple demonstration projects focused on use of decision aids, patient-reported outcome measures, and better communication tools and practices. It designed programs to train clinicians in the art of doctor-patient communication. It used research evidence to inform development of the decision aids that its clinicians use with their patients. And it rigorously measured SDM performance in an ongoing fashion so that progress could be tracked and refined to ensure continuous improvement. Initial data on the institution’s SDM initiatives from the Danish national annual survey of patients’ experiences show substantial progress, thereby motivating Lillebaelt to reassert its commitment to the effort, to share what it has learned, and to invite dialogue among all cancer care organizations as they seek to fully integrate SDM in daily clinical practice.

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