This presentation is part of: Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment
IDENTIFICATION OF MEN WHO WANT HELP WITH PROSTATE CANCER TREATMENT DECISIONS
Sara J. Knight, PhD, San Francisco VA Medical Center, Psychiatry and Urology, San Francisco, CA, Mary-Margaret Chren, MD, San Francisco VA Medical Center, Dermatology, San Francisco, CA, Laura P. Sands, PhD, Purdue University, School of Nursing, West Lafayette, IN, Jamie Grollman, MS, Rosalind Franklin University of Medicine and Science, Psychology, North Chicago, IL, Robert B. Nadler, MD, Feinberg School of Medicine at Northwestern University, Urology, Chicago, IL, and Charles L. Bennett, MD, PhD, Feinberg School of Medicine at Northwestern University, Medicine, Chicago, IL.
Purpose: We sought to understand the role men with prostate cancer would like to play in treatment decision making and to evaluate a multivariate model to identify those who want help from their physicians in making their decisions. Methods: We recruited a cross-sectional sample of 192 men with biopsy confirmed prostate cancer seen in private and university-affiliated clinics. In a telephone interview, the men responded to a question about their preferences to participate in treatment decision making and completed measures of health-related quality of life, prostate cancer specific symptoms, optimism, and perceived involvement in care. Results: Over 75% of the men preferred an autonomous or active role in decision making, i.e., 56% wanted to make the decision themselves after considering physician advice, 22% wanted shared decision making. A minority wanted the physician to make the decision after considering their preferences (14%). Few (1%) wanted make decisions without physician input. White men who were in better health (i.e., better physical function, fewer symptoms) and were more optimistic preferred greater autonomy in decision making(ps=0.001-0.05). When men saw their physicians as discouraging shared decision making, they wanted greater autonomy(p=0.03). However, a multivariate model including these variables did not accurately discriminate among patients according to their preferences for decision making involvement (67% correct classification). Compared to those who wanted a greater patient role in decision making, it was more difficult to classify those who wanted greater physician involvement. Conclusions: Most men want to play a role in prostate cancer decision making, but do not want to be abandoned with the decisions. Men who want greater physician involvement in treatment decision making are more difficult to identify than those who prefer greater autonomy. Direct methods for assessing patient preferences for involvement in decision making are needed.
