IF YOU BUILD THE FIELDS OF SHARED DECISION MAKING DREAMS, CAN PROSTATE CANCER PATIENTS PLAY?

Purpose: Even when patients are educated about their treatment choices, they are often not activated or able to engage with their physicians regarding their treatment values, goals, or preferences. This study tested whether a DVD that taught and modeled shared decision techniques making to prostate cancer patients would improve their self-efficacy for communicating effectively with their physicians (urologists and radiation oncologists) and their report of whether they engaged in shared decision making.

Methods: 564 men undergoing a prostate biopsy were recruited and randomized to receive either a decision aid booklet only or a decision aid booklet + DVD. The DVD follows a patient going through a typical prostate cancer diagnosis visit and modeled shared decision making strategies such as how to better ask questions, question physician recommendations (against active surveillance) and express their values and treatment preferences. Participants who were diagnosed with localized prostate cancer (N=200) completed surveys at recruitment, before learning their diagnosis, and then following their treatment discussion with their medical team. Primary outcome variables included perceived and actual ability to: ask questions, ask for a second opinion, ask for a referral to a radiation oncologist, bring questions, take notes, and participate in shared decision making.

Results: Participants who received the DVD reported stronger intentions to: ask questions (p=0.001), ask for second opinions from another urologist (p=0.001), ask for a referral to see a radiation oncologist (p=0.006), take notes (p=0.001), and to participate in shared decision making (p=0.006). However, when surveyed after meeting with their physicians there were no differences in patients’ perceptions of performing these behaviors with either their urologist or their radiation oncologist (measured separately) during their clinic visit(s).

Conclusions:   Even when patients intend and feel confident about engaging in shared decision making, it is often difficult for them to feel they have succeeded in doing so. It is crucial that we explore methods to better help patients participate in shared decision making at the level they desire.