Method: 1,023 patients presenting to one of four VAs for a prostate cancer biopsy completed baseline measures and were randomized to receive 1 of 2 decision aids. 244 patients diagnosed with prostate cancer completed 2 additional surveys (73% response rate). Time 2 occurred after they had read their decision aid but just prior to receiving their diagnosis. Patients were re-interviewed 1 week later (Time 3), which was following their diagnosis. Electronic medical records were used to determine the treatment patients received. Surveys included measures of treatment preference, literacy, patients’ perceptions of their physicians recommendations and their communication with their physician.
Result: Patients’ preferences for treatment from before they saw their doctor (Time 2) and 1 week later (Time 3) changed significantly: 39% of patients who originally indicated they wanted surgery did not want surgery at Time 3, 43% of those originally expressing interest in active surveillance decided not to pursue that treatment and 77% of those who originally wanted external beam radiation (XRT) did not decide to have XRT. Instability of preferences from Time 2 to the treatment they received was similar: 44% for surgery, 53% for active surveillance, and74% for XRT. In contrast, patients’ preferences at Time 3 were highly related to their physicians’ recommendation the week before: 81% of patients who said their urologists recommended surgery ultimatiely decided on surgery. 82% of those receiving an XRT recommendation chose radiation. Finally, 67% of those whose physician recommended active surveillance reported that as their treatment decision at Time 3. Similarly physicians’ recommendations were strongly related to the treatment patients received: 73% for surgery, 63% for external bema radiation, and 93% for active surveillance. Predictors of stability of patients preferences were prostate cancer related knowledge (p<0.05), literacy (p<0.05) and confidence in decision (from COMRADE, p<0.05).
Conclusion: Even after reading a decision aid prior to talking with their urologist, many prostate cancer patients’ treatment preferences changed after talking with their physician. Patients’ treatment decisions were highly concordant with their urologist’s recommendation. Patients who had greater knowledge of prostate cancer, higher literacy scores and were confident in their decision were more likely to have stable treatment preferences.