Associations between patient knowledge of others' experiences and treatment choice in men with localized prostate cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6578-6578
Author(s):  
Aaron J. Katz ◽  
Ying Cao ◽  
Xinglei Shen ◽  
Deborah Usinger ◽  
Sarah Walden ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
North Carolina ◽  
Cancer Patients ◽  
Treatment Options ◽  
Population Based ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
The North ◽  
Patient Reported

6578 Background: Men with localized prostate cancer must select from multiple treatment options, without one clear best choice. Consequently, personal factors, such as knowing other prostate cancer patients who have undergone treatment, may influence patient decision-making. However, associations between knowledge about others’ experiences and treatment decision-making among localized prostate cancer patients has not been well characterized. We used data from a population-based cohort of localized prostate cancer patients to examine whether patient-reported knowledge of others’ experiences is associated with treatment choice. Methods: The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) is a population-based cohort of localized prostate cancer patients enrolled from 2011-2013 throughout the state of North Carolina in collaboration with the North Carolina Central Cancer Registry. All patients were enrolled prior to treatment and followed prospectively. Patient decision-making factors including knowledge of others’ experiences with prostate cancer treatment options were collected through patient report. Patient treatment choice was determined through medical record abstraction and cancer registry data. Results: Among 1,202 patients, 17% reported knowing someone who pursued active surveillance (AS) while 28%, 46%, and 59% reported knowing someone who received brachytherapy, external beam radiation (EBRT), or radical prostatectomy (RP), respectively; 26% underwent AS, 9% brachytherapy, 21% EBRT, and 39% RP as their initial treatment. In unadjusted analyses, patients with knowledge of others’ experiences with brachytherapy, EBRT or RP had more than twice the odds of receiving that treatment compared to patients who did not. Knowledge of others’ experience with AS was not associated with choice to undergo AS. Multivariable analysis adjusting for age, race, risk group, and patient-reported goals of care showed knowledge of others’ experiences with brachytherapy (OR 4.60, 95% confidence interval [CI] 2.76 to 7.68), EBRT (OR 2.38, 95% CI 1.69 to 3.34), or RP (OR 4.02, 95% CI 2.84 to 5.70) was significantly associated with odds of receiving that treatment. The odds of receiving a particular treatment option were further increased among patients who reported knowing someone who had a “good” experience with the treatment in question. Conclusions: This is the first population-based study to directly demonstrate the impact of a patient’s knowledge of others’ experiences on treatment choice in prostate cancer. These data provide a new consideration to clinicians in their counseling of patients with newly diagnosed prostate cancer, and also impacts research into the informed decision-making process for this disease.

scholarly journals Influence of Men’s Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Elyse Reamer ◽  
Felix Yang ◽  
Margaret Holmes-Rovner ◽  
Joe Liu ◽  
Jinping Xu
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Population Based ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
Curative Treatment ◽  
Risk Level ◽  
Treatment Decision Making ◽  
Choice Decision

Background. Optimal treatment for localized prostate cancer (LPC) is controversial. We assessed the effects of personality, specialists seen, and involvement of spouse, family, or friends on treatment decision/decision-making qualities. Methods. We surveyed a population-based sample of men ≤ 75 years with newly diagnosed LPC about treatment choice, reasons for the choice, decision-making difficulty, satisfaction, and regret. Results. Of 160 men (71 black, 89 white), with a mean age of 61 (±7.3) years, 59% chose surgery, 31% chose radiation, and 10% chose active surveillance (AS)/watchful waiting (WW). Adjusting for age, race, comorbidity, tumor risk level, and treatment status, men who consulted friends during decision-making were more likely to choose curative treatment (radiation or surgery) than WW/AS (OR = 11.1, p<0.01; 8.7, p<0.01). Men who saw a radiation oncologist in addition to a urologist were more likely to choose radiation than surgery (OR = 6.0, p=0.04). Men who consulted family or friends (OR = 2.6, p<0.01; 3.7, p<0.01) experienced greater decision-making difficulty. No personality traits (pessimism, optimism, or faith) were associated with treatment choice/decision-making quality measures. Conclusions. In addition to specialist seen, consulting friends increased men’s likelihood of choosing curative treatment. Consulting family or friends increased decision-making difficulty.

Perceptions regarding prostate cancer (CaP) treatment options: Results from the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study (NC ProCESS).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6530-6530 ◽  
Author(s):  
Ronald C. Chen ◽  
Matthew Edward Nielsen ◽  
Bryce B. Reeve ◽  
Laura H. Hendrix ◽  
Robert P Agans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
Treatment Options ◽  
Population Based ◽  
Robotic Prostatectomy ◽  
External Beam Radiation ◽  
Radiation Oncologist ◽  
Beam Radiation ◽  
The North ◽  
Published Evidence

6530 Background: NC ProCESS is a population-based cohort of early (non-metastatic) CaP patients followed prospectively from diagnosis. Methods: Patients were identified through Rapid Case Ascertainment of the NC Cancer Registry from all NC counties in 2010-12. Phone survey assessed perceptions regarding treatment options and priorities in treatment selection. Results: 937 (59% of all eligible) completed this survey. Median age was 65; 72% were Caucasian. At time of survey, ~13 weeks from diagnosis, 98% had discussed options with a urologist, 49% with primary care, and 41% radiation oncologist. Many patients had concerns about potential effects of surgery and radiation on ability to perform daily activities, recovery time, and burden to family (Table). Open prostatectomy (ORP) and external beam radiation (RT) were deemed most likely to affect urinary and sexual function; fewer reported concern with robotic prostatectomy (RALP). Only 32% reported hormonal therapy would affect sexual function. Most reported surgery (especially RALP) had the best chance for cure, while 59% worried about recurrence with RT. In almost all questions, patients who consulted only with a urologist had significantly different perceptions about treatment options than those who also consulted with a radiation oncologist. In choosing treatment, 61% reported that cure was the highest priority, and 28% indicated preserving quality of life. Conclusions: Modern CaP patients often have misconceptions about treatment options inconsistent with published evidence, which are partially mitigated by multidisciplinary consultation. Most indicated cure as the highest priority, and surgery offers the best chance of cure. [Table: see text]

The North Carolina–Louisiana Prostate Cancer Project (PCaP): Methods and design of a multidisciplinary population-based cohort study of racial differences in prostate cancer outcomes

The Prostate ◽  
2006 ◽  
Vol 66 (11) ◽  
pp. 1162-1176 ◽  
Author(s):  
Jane C. Schroeder ◽  
Jeannette T. Bensen ◽  
L. Joseph Su ◽  
Merle Mishel ◽  
Anastasia Ivanova ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
North Carolina ◽  
Cohort Study ◽  
Racial Differences ◽  
Population Based ◽  
Cancer Outcomes ◽  
The North ◽  
Cancer Project

Survival gains needed to justify the side effects of treatment for localized prostate cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5119-5119
Author(s):  
M. T. King ◽  
R. Viney ◽  
I. Hossain ◽  
D. Smith ◽  
E. Savage ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Treatment Options ◽  
Relative Survival ◽  
Random Parameter ◽  
Population Based ◽  
Localized Prostate Cancer ◽  
Common Side Effect ◽  
Base Case ◽  
Compensating Variation

5119 Background: Men diagnosed with localized prostate cancer face difficult treatment decisions. Evidence about the relative survival benefit of treatment options is lacking or piecemeal. Side-effects can vary widely with treatment, affecting some fundamental aspects of quality of life (QOL). Little is known about patients’ views of the relative tolerability of these side-effects or the survival gains needed to justify them. Methods: QOL data were collected prospectively 3 years post-diagnosis in a population-based cohort of men treated for localized prostate cancer (n=1642); these data were used to identify common side-effect profiles. A patient preference survey was conducted in a subset (n=357, stratified by treatment); hypothetical treatment alternatives were described in terms of side-effects and survival. Random parameter logit models were estimated. We adapted the concept of compensating variation from welfare economics to derive a parameter function for the value of changes in QOL in terms of survival time; i.e., the survival gains needed to justify persistent side-effects. Bootstrap confidence intervals (CI) were constructed. Results: The table shows the survival gains needed for a range of common treatment profiles, relative to the base case of active surveillance (in which men typically experienced mild loss of libido and mild fatigue). For example, radical prostatectomy often resulted in severe impotence and mild urinary leakage; men required an extra 8.0 months (95% CI 7.4–8.7) of life to make this worthwhile. Generally, urinary dysfunction and bowel symptoms were considered the least tolerable, hormonal symptoms and fatigue came next, and sexual dysfunction was considered relatively benign. This pattern was relatively consistent across treatment groups. Conclusions: These results highlight the need for better evidence about the actual survival benefits of alternative treatments. They also help to target supportive care to optimize patient QOL after treatment for localized prostate cancer. [Table: see text] No significant financial relationships to disclose.

Personal preferences and treatment choice in an intervention trial of men newly diagnosed with localized prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 170-170
Author(s):  
Jaclyn Lee Fong Bosco ◽  
Barbara Halpenny ◽  
Donna Lynn Berry
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Treatment Options ◽  
Bowel Dysfunction ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
Control Group ◽  
Online Questionnaire ◽  
Patient Profile ◽  
Significant Difference

170 Background: Men diagnosed with localized prostate cancer (LPC) can choose from multiple treatment regimens and are faced with a decision in which medical factors and personal preferences are important. The Personal Patient Profile-Prostate (P3P) is a computerized decision aid for men with LPC that focuses on personal preferences. We determined the proportion of men with LPC who chose a concordant treatment approach by 6-months with self-reported, influential side effects by intervention or control group, and evaluated whether the intervention (versus control) group was more likely to choose a concordant treatment. Methods: English or Spanish-speaking men diagnosed with LPC (2007–2009) from four US cities were enrolled into a randomized trial and followed at 1- and 6-months via mailed or online questionnaire. Men were randomized to receive the P3P intervention or standard education plus links to reputable websites (control group). We classified concordance as men who were (a) concerned with urinary incontinence and/or erectile dysfunction and chose radiotherapy, (b) concerned with bowel dysfunction and chose prostatectomy, (c) concerned with all three side effects and chose watchful waiting, or (d) not concerned with any side effect and chose any treatment. We calculated the proportion of concordance by group. Using logistic regression, we calculated odds ratios (OR) and 95% confidence intervals (CI) for the association between the P3P intervention and concordance. Results: Of 448 men, most were <65 years, non-Hispanic white, and had multiple physician consultations prior to study enrollment. Only 43% of the sample chose a concordant treatment given concerns about potential side effects. There was no significant difference in concordance between the intervention (43%) and control (42%) group (OR=1.1; 95%CI=0.73, 1.7). Conclusions: The P3P intervention was not associated with concordance between potential side effects and treatment choice. Information and/or physician consultation immediately after diagnosis was likely to influence decisions despite concerns about side effects. The intervention may be more effective before the first treatment options consultation.

A population-based study examining the impact of a multidisciplinary rapid access clinic on utilization of initial treatment options for patients with localized prostate cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 15-15
Author(s):  
Clement K. Ho ◽  
Joseph D. Ruether ◽  
Bryan J Donnelly ◽  
Marc Kerba
Keyword(s):  
Prostate Cancer ◽  
Initial Treatment ◽  
Treatment Options ◽  
Population Level ◽  
Treatment Decisions ◽  
Population Based ◽  
Localized Prostate Cancer ◽  
Rapid Access ◽  
Rapid Access Clinic ◽  
The Impact

15 Background: Treatment decisions in localized prostate cancer (LPCa) are complicated by the variety of available options. A rapid access cancer clinic (RAC) has been unique to Calgary, Alberta (AB) since 2007. RAC offers multidisciplinary prostate cancer care by a urologist, medical oncologist, and radiation oncologist. It is hypothesized that treatment utilization data from decisions taken at RAC may serve to benchmark the appropriateness of treatment decisions on a population level. Objectives: To compare utilization rates for initial treatment of LPCa between AB and RAC. Methods: Records of patients with clinically LPCa in AB between 2007-9 were reviewed with ethics approval. Records were linked to the AB cancer registry database. Clinical, treatment and health services characteristics pertaining to patients attending RAC were compared to those managed elsewhere in AB. The primary endpoints were utilization rates by initial treatment; prostatectomy (P), radiotherapy (RT), hormone therapy (H), active surveillance (A). A logistics regression model was constructed to examine the influence of RAC on initial treatment decisions, while controlling for interactions and factors of interest. Results: 2,660 patients were diagnosed with LPCa. 375 presented to RAC. Utilization rates among RAC patients: P-60.3% (95%CI: 55.3-65.2), A-16%(12.3-19.7), RT-11.7%(8.5-15.0) and H-8.0%(CI:5.2-10.8). This compares to AB rates of P-47.2%(45.9-48.3), A-6.1%(15.2-17.0), RT-18.8%(17.9-19.7), and H-14.5%(13.6-15.4). On multivariate analysis, RAC was associated with a trend towards receiving RT (OR 1.6, p=0.097). Conclusions: A specialized clinic for LPCa may be associated with a higher likelihood of receiving radiotherapy as initial treatment compared to the prostate cancer population in Alberta.

Patient-reported financial toxicity following management of localized prostate cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17053-e17053
Author(s):  
Brandon S. Imber ◽  
Amy L. Tin ◽  
Andrew Vickers ◽  
James Andrew Eastham ◽  
Michael J. Zelefsky ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Additive Models ◽  
Localized Prostate Cancer ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Financial Toxicity ◽  
Treatment Type ◽  
Patient Reported

e17053 Background: Cancer patients’ potential for severe financial toxicity (FT) is well-established, however there is limited data on the magnitude of this challenge associated with treatment of localized prostate cancer (PC). The extent to which men consider potential financial implications prior to selection of a treatment strategy remains poorly understood. Methods: Between 5/2020-10/2020, 1233 insured PC patients treated at a comprehensive cancer center completed a one-time FT survey which included the COmprehensive Score for financial Toxicity (COST) instrument, impressions of PC costs and financial coping strategies. Inclusion criteria was localized disease and treatment with either radical prostatectomy (RP) or definitive radiotherapy (RT) in the previous 4-26 months (mo) or at least 6mo of active surveillance (AS) prior to survey. To assess possible temporal differences in FT, responses were grouped into 6, 12, 18 and 24 months after treatment start, and we plotted COST against time, using generalized additive models to allow for non-linearity. Results: Overall, 988 men were eligible for analysis: 347 (35%) underwent RP, 384 (39%) underwent RT, and 257 (26%) were on AS. The median age at survey completion was 67 years (quartiles 62, 72). Men were predominantly white (89%), English-speakers (99%) and married (84%). The median (quartiles) COST score for all patients was 33 (26, 38) with possible range of 0-44 with lower scores indicating greater FT; median values were identical with similar quartiles (+/- 1 point) when stratified by treatment type. There were no significant changes in median COST between men surveyed at the four time points for any treatment subgroup. In total, 66 men (7.1%) reported spending > 20% of annual income on treatment and 10% felt that PC has created at least somewhat of a financial hardship for their family. Top drivers of burdensome cost included medical bills (37%) and transportation costs (21%). Most (83%) reported giving little or no consideration to possible costs prior to making a PC treatment decision, yet the majority (77%) felt that out of pocket costs should be communicated to a patient prior to decision making. Most believed patients should definitely (46%) or possibly (33%) have the opportunity to discuss financial concerns with the radiation oncologist or urologist. Conclusions: Our study is the first reported use of the COST instrument to assess subjective financial distress in localized PC patients. Our results demonstrate that the overall degree of FT in this cohort of insured patients treated at a specialized cancer center is low. While potential financial burden does not strongly influence treatment decision making in this cohort, most want this information and an opportunity to discuss financial concerns with their oncologist. Next steps include identification of predictors for high FT risk and extension of our survey to hospital systems with differing demographic profiles.

scholarly journals Patient-Centered Approach to Develop the Patient’s Preferences for Prostate Cancer Care (PreProCare) Tool

2019 ◽  
Vol 4 (1) ◽  
pp. 238146831985537 ◽  
Author(s):  
Ravishankar Jayadevappa ◽  
Sumedha Chhatre ◽  
Joseph J. Gallo ◽  
S. Bruce Malkowicz ◽  
J. Sanford Schwartz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Focus Groups ◽  
Cancer Patients ◽  
Cancer Care ◽  
Assessment Tool ◽  
Preference Assessment ◽  
Localized Prostate Cancer ◽  
Advisory Group ◽  
Patient Centered

Objectives. To describe the development of our Patient Preferences for Prostate Cancer Care (PreProCare) tool to aid patient-centered treatment decision among localized prostate cancer patients. Methods. We incorporated patient and provider experiences to develop a patient preference elicitation tool using adaptive conjoint analysis. Our patient-centered approach used systematic literature review, semistructured patient interviews, and provider focus groups to determine the treatment attributes most important for decision making. The resulting computer-based PreProCare tool was pilot tested in a clinical setting. Results. A systematic review of 56 articles published between 1995 and 2015 yielded survival, cancer recurrence, side effects, and complications as attributes of treatment options. We conducted one-on-one interviews with 50 prostate cancer survivors and 5 focus groups of providers. Patients reported anxiety, depression, treatment specifics, and caregiver burden as important for decision making. Providers identified clinical characteristics as important attribute. Input from stakeholders’ advisory group, physicians, and researchers helped finalize 15 attributes for our PreProCare preference assessment tool. Conclusion. The PreProCare tool was developed using a patient-centered approach and may be a feasible and acceptable preference clarification intervention for localized prostate cancer patients. The PreProCare tool may translate into higher participant engagement and self-efficacy, consistent with patients’ personal values.

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