BOOKLET TALK: PATIENT USE OF DECISION AIDS IN PROSTATE CANCER DIAGNOSIS ENCOUNTERS

Sunday, October 19, 2014
Poster Board # PS1-8

Margaret Holmes-Rovner, PhD, Center for Ethics, East Lansing, MI, David Rovner, MD, Michigan State University, East Lansing, MI, Akshay Srikanth, BS, Michigan State University College of Human Medicine, East Lansing, MI, Valerie C. Kahn, MPH, University of Michigan, Ann Arbor, MI, Stephen Henry, MD, University of California Davis, Sacramento, CA, Peter A. Ubel, MD, Duke University, Durham, NC and Angela Fagerlin, PhD, VA Ann Arbor Healthcare System & University of Michigan, Ann Arbor, MI
Purpose: To describe patients’ spontaneous discussion of prostate cancer decision aids (DAs) in making treatment decisions with their physicians. Little is known about how patients use DAs in clinical encounters when the DAs are systematically provided within the clinical setting, prior to patients’ receiving their cancer diagnosis.

Methods: We analyzed transcripts of 252 audiotaped office visits of urologists delivering a diagnosis to patients with localized prostate cancer. All patients were participating in a randomized trial of two DAs for prostate cancer, a plain language DA vs. a high literacy DA. Participants were men with clinically localized prostate cancer (PSA<20; Gleason 6 or 7) seen in outpatient urology clinics in 4 Veterans Affairs Medical Centers by 55 physicians. Physicians received no training in DA use or shared decision making. We coded the specific DA references for topic discussed and function in the visit.

Results: References to a DA occurred in 138 encounters (54.8%), with 70% of those initiated by the patient. In post-visit surveys, 62% of patients reported bringing the DA to the clinic. Patients randomized to the plain language DA were more likely to reference it in the encounter (p=.02). Within the set of patient references to DAs, the patient comments generated by the plain language DA more frequently elicited a physician response (p<.01). The most common topic discussed was detail about surgical technique (36%); 24% addressed treatment choice or decision; 17% asked for clarification of risk classification. The most frequent function was patient corroboration that the physician’s statement matched what he read in the DA (42%); 28% simply acknowledged the patient had the DA with him; 12% used the DA to ask a question. A small minority (4%) used the DA to challenge the physician.   

 Conclusions: Just over half of encounters contained explicit references to the DA during the diagnosis visit, most frequently to corroborate or expand on physician-delivered information. The plain language DA generated more DA references, and more patient-physician exchanges. This suggests the plain language DA supported more active two-way communication in the informing and decision making process.

See more of: POSTER SESSION I & WELCOME RECEPTION

See more of: The 36th Annual Meeting of the Society for Medical Decision Making