HOW DO PATIENT DECISION AIDS FOR PROSTATE CANCER TREATMENT PRESENT INFORMATION?

Purpose: Despite established evidence for using patient decision aids (DA) for newly diagnosed prostate cancer (PCa) patients, implementation of these tools remains limited, partly due to variability in the characteristics of DAs. The aim of this study was to review characteristics of DAs for newly diagnosed PCa patients.

Method: MEDLINE, Web of Science, and PsychInfo were searched for articles in peer reviewed journals from database inception to October 2013. In addition a separate search was conducted with similar search terms using the Google search engine. Decision aids that were freely available on the internet with or without published studies, related to treatment of prostate cancer, for patients, and written in the English language only were included in the study. The search strategy retrieved a total of 15 patient DAs specific to PCa treatment. DAs were assessed based on the previously validated International Patient Decision Aid Standards (IPDAS) and implementation criteria. Three reviewers conducted study selection and assessment independently and resolved discrepancies by consensus.

Result: Development process and format: Of the 15 DAs, 8 were developed in US. Most were either web based (7), print based (5) or both (5). Ten tools were geared towards a specific stage of prostate cancer (i.e. early stage, advanced, metastatic). Content: Treatment options discussed included surgery (14), radiation (15), active surveillance (10), watchful waiting (10), and hormonal therapy (8). Four tools used alternate formats (graphics, audio, and videos). The average readability score was at grade 10th level (range 6-16th grade) with 6 DAs written at grade 8 or lower readability level. Effectiveness and implementation: Only 4 DAs had published effectiveness studies. No DAs provided information on their implementation process.

Conclusion: No DAs met all the IPDAS. Content, format and presentation of PCa information within DAs varied significantly. Critical issues such as overtreatment and watchful waiting were not covered in all DAs. The tools were not always written using plain language and very limited information was available regarding the effectiveness and implementation of these tools. Considerable variability exists among decision aids for patients making prostate cancer related decisions. As physicians look to adopt decision aids for their practice, they may base the choice of decision aids on the characteristics of the decision aid depending upon their patient populations and practice settings.