PERCEPTIONS OF UROLOGISTS TOWARDS SHARED DECISION MAKING AND DECISION AIDS FOR PROSTATE CANCER TREATMENT

Purpose: Although the evidence base for effectiveness of decision aids (DA) exists, widespread adoption and implementation in routine practice, especially for urologists, has been limited. The study aims to describe perspectives of Urologists about the process of shared decision making, the role of DAs and their potential for adoption with newly diagnosed prostate cancer (PCa) patients facing treatment decisions.

Method: Participants included 12 community and academic Urologists practicing in the St. Louis region. Researchers conducted semi-structured interviews where DAs were presented to the urologists to ascertain their perspectives on adoption. Data was analyzed using a grounded theory approach.

Result: All participants routinely spent 30 mins to an hour with newly diagnosed PCa patients when having treatment discussions with their patients. Family members were encouraged to be involved in the discussion and most often included spouses or children of the men. Initial discussions included a presentation of treatment options available, side effects, outcome probabilities and next steps. Urologists also recognized the over diagnosis and over treatment prevalent with PCa and mentioned recommending active surveillance more often. Most urologists encouraged patients to postpone their decisions till the next encounter, given the emotional burden associated with cancer diagnosis. None of the urologists had clinical staff participate in the discussions. All participants used some tools to aid in discussions but most were produced by pharmaceutical companies. Urologists acknowledged the usefulness of using DAs in their conversations but expressed a preference for materials that were plain language, unbiased, short and paper based to be implemented in their practice. Additionally, they emphasized the importance of one-on-one conversations with the patients and their families. Urologists mentioned multiple factors that influenced conversations like the diagnostic process, the screening recommendations, beliefs in evidence based medicine and their motivations to practice shared decision making.

Conclusion: Urologists routinely practiced most elements of shared decision making. While most urologists used some tools in practice, most were not evidence based or unbiased. Although urologists interviewed were unaware of the freely available DAs, they were welcoming of DAs presented. They were concerned with the emotional and health literacy needs of their patients and preferred different DAs depending upon their patient populations and practice styles. The role of the clinical staff in mediating these discussions needs to be further explored.