CAREGIVERS' AND PATIENTS' RESPONSES TO THE IMPLEMENTATION OF A DECISION AID FOR PROSTATE CANCER TREATMENT

Purpose: To examine the implementation and the effect of a decision aid (DA) for prostate cancer treatment.

Method: As part of a larger implementation project in the Netherlands (JIPPA study), this study involved 30 caregivers (urologists and oncology nurses) in 8 hospitals, who presented a DA to patients with localized prostate cancer. All patients with more than one treatment option according to the urologist (surgery, external radiotherapy, brachytherapy and/or active surveillance) were eligible. Both the caregivers and the patients filled out questionnaires on decision making and on the use of the DA. A control cohort of 64 patients without DA filled out the decision making part of the questionnaire. The implementation rate was estimated using national cancer registry data on the number of eligible patients per hospital.

Result: The overall implementation rate in the participating hospitals was 78%, ranging from 30% to 100%. Over a period of 12 months, 295 eligible patients received the DA and were asked to participate, of whom 255 (86%) filled out the questionnaire. Most patients (88%) had used the DA to reach a treatment decision, and the majority (83%) indicated that it added (very) much to other information they received. In addition, the DA led to more knowledge (P<0.001), and to less decisional conflict on values clarity (P=0.003) compared to control patients. Moreover, the decision aid increased the awareness of having more than one treatment option; only 29% of the control patients vs. 62% of the DA patients indicated that they were eligible for two or more treatment options.

   Of the caregivers, 24 (80%) responded. Six of them (25%) did not always use the DA for various reasons (forgotten, patient nervous, patient had already decided, patient unwilling). Time was not an important barrier or facilitator for using the decision aid. The barrier that was most often confirmed by the caregivers, was “the DA should focus more on active surveillance” (50% agreed). The most confirmed facilitator was that “use of the DA fitted well with the guidelines” (100% of caregivers agreed).

Conclusion: The DA was well received, and used by most caregivers and patients. It was effective on knowledge and decisional conflict and, foremost, it increased the perception of having treatment options to choose from.