DECISIONAL CONFLICT IN PROSTATE CANCER TREATMENT DECISION MAKING: HOW EFFECTIVE IS INFORMATION PROVISION?

Purpose:

The treatment of prostate cancer offers multiple medically equivalent alternatives. In the absence of a superior approach, patients preferences are essential to select the best suiting treatment. To allow patients in making an informed decision, information provision is a crucial step. The purpose of this study was to evaluate the effectiveness of information provision and the potential presence of decisional conflict during treatment decision making among patients newly diagnosed with prostate cancer.

Method:

A prospective study involved 349 patients scheduled for prostate biopsy (T0) from ten Dutch hospitals and followed them through the treatment decision making process (T1). Participants received a paper-and-pencil questionnaire after their first consultation for prostate biopsy. In case of a positive biopsy for prostate cancer (n=70), participants received a second questionnaire after treatment decision making. Measures included the 12-item Knowledge of Prostate Cancer Questionnaire (at T0 and T1) and the Decisional Conflict Scale (DCS; at t1).

Result:

Results show a minimal increase in prostate cancer knowledge between T0 and T1. At baseline (T0) 12% of the participants was able to answer at least 8 out 12 questions correct (yes/no scale). After information provision and decision making (T1), this was improved to only 25% of the patients. On the Decisional Conflict scale (0-100), the mean score was 42, indicating a moderate level of decisional conflict when making the treatment decision. Subscales of the DCS revealed relatively high mean scores for feeling uninformed  (m=59, with 85% scoring >50) and uncertainty about best choice (m=62, with 80% scoring > 50). This indicates that many treatments decisions have been made with feelings of being uninformed and uncertainty about which treatment alternative would be best.

Conclusion:

In a sample of newly diagnosed patients with prostate cancer we observe only a small increase of knowledge after information provision. This finding suggest that the effectiveness of information provision can be improved. During the decision making process an assessment is needed if patients have an adequate understanding of the information that was provided and if they are feeling certain enough to make a decision. A more tailored approach of information provision and decision support should be taken into account if patients demonstrate feelings of being uninformed or uncertain of which choice is best.