Prostate cancer treatment choices: the GP’s role in shared decision making

e16576 Background: Shared decision-making is the process of deliberately interacting with patients who wish to make informed value-based choices, when there are no indicated best treatment options. Given the wide variation in prostate cancer treatment options, clinical decision-support systems (CDSS) may effectively support treatment decisions for patients with challenging risk-benefit profiles. However, limited data are available regarding CDSS in shared decision making. This study aimed to assess the alignment of CDSS therapeutic options with treatment received through a shared decision process. Methods: We identified patients with prostate cancer (Gleason Groups 1-5) who were engaged in shared treatment decision making, (from August–September 2018) at the Instituto do Câncer do Ceará, Brazil. IBM Watson for Oncology (WfO), a CDSS was used for the study. Treatment decisions were compared with WfO options (active surveillance, clinical trial, chemotherapy [CT], hormone therapy [HT], radiation [RT], brachytherapy [brachy], surgery and systemic therapy with GnRH suppression) and categorized as concordant (equivalent), partially concordant (a partial match), or discordant. Results: Concordance between WfO and shared treatment decisions was observed in 54% (26/48) of patients, partial concordance in 15% (7/48) and discordance in 31% (15/48). Most frequent treatments were RT+HT combination therapy (25%) and prostatectomy (21%). 8/15 (53%) discordant cases were due to patient preference for treatment over active surveillance. Patient preference for treatment over active surveillance was the most common reason (53%) for discordance. Conclusions: Variation in prostate cancer treatment exists. CDSS therapy options may be useful in quantifying and modifying unwarranted variations in prostate cancer treatment. Future studies are important for understanding reasons for variations. [Table: see text]

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Patient preference and the impact of decision-making aids on prostate cancer treatment choices and post-intervention regret

Current Oncology ◽

10.3747/co.19.1287 ◽

2012 ◽

Vol 19 (S3) ◽

Cited By ~ 21

Author(s):

J. Aning ◽

R.J. Wassersug ◽

S.L. Goldenberg

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Cancer Treatment ◽

Patient Preference ◽

Post Intervention ◽

Prostate Cancer Treatment ◽

Treatment Choices ◽

The Impact

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Health literacy is a barrier to shared decision making in early prostate cancer (PCA) among African American (AA) men.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.84 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 84-84 ◽

Cited By ~ 1

Author(s):

William Martin-Doyle ◽

Christopher Paul Filson ◽

Susan Regan ◽

Quoc-Dien Trinh ◽

Sierra Williams ◽

...

Keyword(s):

Decision Making ◽

African American ◽

Health Literacy ◽

Cancer Treatment ◽

Shared Decision Making ◽

Treatment Options ◽

Univariate Analysis ◽

Shared Decision ◽

Newly Diagnosed ◽

Treatment Choices

84 Background: ASCO, AUA, ASTRO and SUO endorse shared decision making for men with localized PCa. We explored treatment decisions among providers and their AA patients (pts) in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Following their visit, 18 providers documented the PCa treatment options they had discussed with 124 newly diagnosed, early-stage, African American PCa pts. At a subsequent visit, prior to choosing their cancer treatment, pts were asked to name the options they had discussed with their provider. Demographics were collected. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods (Kilbridge K, et al. J Clin Oncol 27:2015-2021, 2009). Chi-square, t-tests and multivariate logistic regression were used to identify variables associated with correct understanding of treatment choices. Results: Just 23.4% of pts correctly understood their treatment options. In univariate analysis, only health literacy was statistically significantly associated with comprehension of PCa treatment options (p < 0.05). In a multivariate logistic model adjusting for age, education, income, numeracy, comprehension of common PCa terms, and anatomic knowledge; health literacy remained the only significant predictor of pts’ comprehension of their treatment choices (OR 3.8, 95% CI 1.2-11.9, p = 0.021). Even among the 49 pts with the highest level of health literacy, only 34.7% correctly understood their cancer treatment options (compared to 16.0% among low literacy patients). Conclusions: Successful shared decision making requires pts to understand their treatment choices. Information presented by healthcare providers may be overwhelming for newly diagnosed pts, particularly those with lower health literacy. Our study suggests that even pts with the highest level of health literacy may need additional support to understand their PCa treatment options.

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Treatment for Early Stage Prostate Cancer

10.1093/med/9780190647421.003.0017 ◽

2018 ◽

Author(s):

Sarah C. Kobrin ◽

Alex Conway

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Side Effects ◽

Cancer Treatment ◽

Implementation Science ◽

Standard Treatment ◽

Early Stage ◽

Shared Decision ◽

Prostate Cancer Treatment

Men diagnosed with early stage prostate cancer will very likely survive many years after their prostate cancer treatment, regardless of which standard treatment is used. This case study describes a situation in which all standard treatments are supported by evidence but side effects vary greatly. In this situation, a partnership is needed between the doctor and the patient to choose the best option. This case study gives a brief overview of the complexities of choosing a treatment for early state prostate cancer and how implementation science is needed to (1) consider effectiveness and implementation together and (2) identify factors that inhibit and enhance the implementation and sustainability of shared decision-making.

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PD40-07 ADDRESSING HEALTH LITERACY IMPROVES SHARED DECISION MAKING IN UNDERSERVED AFRICAN AMERICAN PROSTATE CANCER PATIENTS

The Journal of Urology ◽

10.1097/ju.0000000000000920.07 ◽

2020 ◽

Vol 203 ◽

pp. e817-e818

Author(s):

Kerry Kilbridge ◽

William Martin-Doyle* ◽

Christopher Filson ◽

Quoc-Dien Trinh ◽

Sierra Williams ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

African American ◽

Health Literacy ◽

Cancer Patients ◽

Shared Decision Making ◽

Shared Decision

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Preparing Patients with Early Stage Prostate Cancer to Participate in Clinical Appointments Using a Shared Decision Making Training Video

Medical Decision Making ◽

10.1177/0272989x211028563 ◽

2021 ◽

pp. 0272989X2110285

Author(s):

Karen Scherr ◽

Rebecca K. Delaney ◽

Peter Ubel ◽

Valerie C. Kahn ◽

Daniel Hamstra ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Early Stage ◽

Controlled Trial ◽

Treatment Decision ◽

Shared Decision ◽

Plain Language ◽

Training Video ◽

Video Group

Background Rates of shared decision making (SDM) are relatively low in early stage prostate cancer decisions, as patients’ values are not well integrated into a preference-sensitive treatment decision. The study objectives were to develop a SDM training video, measure usability and satisfaction, and determine the effect of the intervention on preparing patients to participate in clinical appointments. Methods A randomized controlled trial was conducted to compare a plain-language decision aid (DA) to the DA plus a patient SDM training video. Patients with early stage prostate cancer completed survey measures at baseline and after reviewing the intervention materials. Survey items assessed patients’ knowledge, beliefs related to SDM, and perceived readiness/intention to participate in their upcoming clinical appointment. Results Of those randomized to the DA + SDM video group, most participants (91%) watched the video and 93% would recommend the video to others. Participants in the DA + SDM video group, compared to the DA-only group, reported an increased desire to participate in the decision (mean = 3.65 v. 3.39, P < 0.001), less decision urgency (mean = 2.82 v. 3.39, P < 0.001), and improved self-efficacy for communicating with physicians (mean = 4.69 v. 4.50, P = 0.05). These participants also reported increased intentions to seek a referral from a radiation oncologist (73% v. 51%, P = 0.004), to take notes (mean = 3.23 v. 2.86, P = 0.004), and to record their upcoming appointments (mean = 1.79 v. 1.43, P = 0.008). Conclusions A novel SDM training video was accepted by patients and changed several measures associated with SDM. This may be a scalable, cost-effective way to prepare patients with early stage prostate cancer to participate in their clinical appointments. [Box: see text]

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