CHOOSING A PROSTATE CANCER TREATMENT: CAN INTEGRATED DECISION AIDS IMPROVE PATIENT DECISION MAKING?

Purpose: Deciding among the treatment options for prostate cancer can be challenging.  Systematic reviews have shown improved decision making in patients exposed to decision aids (DAs). The purpose of this study was to integrate a DA into the clinical pathway for newly diagnosed prostate cancer patients and to assess the impact on decision making.

Methods: From September 2007 – February 2008, a prospective cohort of 81 patients with early stage prostate cancer were followed.  Prior to consultation with their urologist, patients are mailed a cover letter, informational pamphlets, and a video DA which includes facts about prostate cancer, treatment options, and testimony from patients[1]. Participants then complete an online questionnaire that captures clinical and decision making data. A summary report of responses is available to the urologist for use during the consultation.  Measures include: demographics, treatment intention, knowledge test of key facts associated with the decision, degree of decisional conflict, and satisfaction with the process.

Results: Of the 81 patients, 53 (66%) indicated they watched the video decision aid.

PrCA Patients * P ≤ 0.05	N	Survival Knowledge	Clear Values	Feels Informed	Enough Support	Sure about Treatment Choice
Watched DA	53	75%	88%	80%	66%	48%
Did not watch DA	28	36%*	63%*	61%*	64%	42%

Preliminary results indicate that patients who watched the video decision aid had a better understanding of the survival rate for prostate cancer (75% vs. 36% correct on knowledge question), and were more likely to feel informed and clear about what matters most to them. No differences were observed for baseline treatment intention or certainty about their choice.  The majority of patients had favorable feedback: 98% felt the information on treatment options was balanced; 92% indicated the length of the DA was “about right”; overall ratings were “Good” (51%), “Very Good” (24%), or “Excellent” (22%).

Conclusions: For these men, the DA appears to provide important information and help reduce decisional conflict due to unclear values and knowledge gaps. Consequently these patients feel more confident and prepared for their appointment with their physician.  Preliminary results suggest that a video decision aid integrated into usual care for prostate cancer treatment can improve patient decision making.  

[1] Treatment Choices for Prostate Cancer, a Foundation for Informed Medical Decision Making Shared Decision-Making^© Program, 2006.