PROVIDER ENCOURAGEMENT OF SHARED DECISION MAKING AMONG NEWLY DIAGNOSED PATIENTS WITH LOCAL STAGE PROSTATE CANCER

Purpose.   To examine the influence of providers in encouraging shared decision-making with newly diagnosed prostate cancer patients and their families.

Methods.   We recruited 192 newly diagnosed patients with local stage prostate cancer and their family members prior to treatment from 3 racially diverse urology practices in Los Angeles, Charleston, and San Antonio.  Data were collected from patients, family members and providers about treatments being considered or recommended and individual preferences for key aspects of treatment including side effects, worry, anxiety and personal beliefs.  We explored two dimensions of shared decision making - how often family members reported discussing treatment options with their loved one and whether family members perceived their role was to help make the final treatment decision.  Using multivariate logistic regression, we compared family members who reported very frequent discussions of treatment options with those who reported less frequent or little discussion with their loved one.  Independent variables included race, age, clinical characteristics, and 4 items indicating how much providers encouraged patient involvement in the decision process.

Results.   A total of 43% of family members reported “very frequent” discussions with their loved one, and 67% perceived their role was to help make the final treatment decision.  Family members of black and Hispanic patients were less likely than whites to report discussing treatment options (p=0.046) but more likely to indicate their role was to make the final decision (p=0.006).  Half of patients reported providers encouraged them to be involved in all aspects of the decision process.  Black and Hispanic patients reported higher rates of encouragement by providers than whites (p=0.034).  In Multivariate models, neither black race (OR 0.50 p=0.23), nor Hispanic ethnicity (OR 0.79 p=0.68) were strongly predictive of shared decision making between patients and family members compared to whites. However, receiving care from VA or military (OR 0.22, p=0.01), and having PSA >10 (OR 0.26, p=0.04) were associated with less involvement.  Family member involvement was nearly twice as great among those families in which patients reported physician encouragement in the decision process (OR 1.98, p=0.05). 

Conclusion.   Physician encouragement of involvement in the decision process is associated with increased family shared decision making.