DECISION COUNSELING ABOUT ACTIVE SURVEILLANCE AND ACTIVE TREATMENT FOR EARLY STAGE LOW RISK PROSTATE CANCER PATIENTS

Purpose: Nationally, most patients with low risk prostate cancer undergo active treatment (AT) with surgery or radiation therapy, even though research shows there is no significant difference in mortality for patients who have AT and those who have active surveillance (AS) with periodic blood tests and biopsies.  A pilot study of treatment decision making is being conducted in men with low risk prostate cancer presenting at a multidisciplinary genitourinary cancer clinic.

Method: Men with low-risk prostate cancer who present to the multidisciplinary clinic are approached by a research assistant, who consents participants and administers a baseline survey.  A nurse then meets each participant to conduct a decision counseling session.  In the session, the nurse and participant review information on treatment options (AS versus AT).  The nurse elicits the participant’s pro and con decision factors that influence treatment preference, determines specific and relative decision factor weights, and enters these data into an online Decision Counseling Program©.  Then, the nurse generates a 1-page summary report that displays the participant’s derived treatment preference score (0.000-1.000), related decision factors, and remaining patient questions about treatment.  The report is reviewed with the participant to verify its accuracy and completeness; and a copy is provided to the participant and members of the clinical team for use in shared decision making in the visit.  Subsequent to the visit, a 30-day telephone survey is administered.  Change in treatment-related knowledge and decisional conflict is measured using baseline and 30-day survey data.  Treatment status is assessed on the 30-day survey.

Result: Among 12 participants, preference scoring showed that at baseline, 3 participants favored AS (1.000-0.583), 8 had an equal preference for AS and AT (0.582-0.417), and 1 preferred AT (0.416-0.000).  At 30 days, 9 participants had initiated AS, while 3 chose AT; participant mean treatment knowledge scores (8-point scale) had increased (+0.92 points); and decisional conflict subscale scores (strongly disagree = 1, strongly agree = 5) had decreased (uncertain: -1.2, uninformed: -1.3, unclear: -0.9; and unsupported: -1.2).

Conclusion: From baseline to endpoint, participants were better informed, felt less decisional conflict about treatment decision making, and moved from being undecided about AS versus AT to favoring AS. Ongoing study recruitment and data collection are planned to obtain information on the stability and magnitude of intervention effects.