FIRST USER EXPERIENCES FROM A MULTI-CENTER IMPLEMENTATION OF A WEB-BASED PROSTATE CANCER TREATMENT DECISION AID IN THE NETHERLANDS

Purpose:

Multiple oncologically equivalent options are available for prostate cancer (Pca) treatment. Selecting the best suiting treatment can be burdensome for many patients as it involves clarifying values and weighing risks and benefits involved to each alternative. Therefore, treatment selection in Pca should ideally be a shared physician-patient decision. To support this process a novel Dutch web-based treatment decision aid has been developed to optimally fit clinical workflow.

Method:

As part of a cluster RCT, 9 hospitals implemented the DA in clinical practice and another 9 hospitals deliver care-as-usual. A first questionnaire is sent after treatment decision making, but before treatment is started. Main outcomes of this questionnaire are the evaluations of information provision and the (shared) decision making process. Additionally, twenty clinicians were asked for an evaluation of working with the DA.

Result:

Within six months the DA was consulted by 100 Pca patients and 63 of these patients completed the first questionnaire. Uptake per hospital varied between 30 and 1. Most patients received the DA within a week after diagnosis (76%), however nearly a quarter (24%) received the DA more than a week after diagnosis. A substantial part of the DA users (70%) stated the same treatment preference after DA consultation as at the start of the DA. From the DA users, 58% indicated the DA was of added value and 62% indicated that the DA helped decision making and motivated them to ask their urologist questions. A comparable proportion of clinicians (58%) confirm that the DA is helping to discuss treatment options. Patients and urologists discussed the summary obtained from the DA in 68% of the follow-up encounters.

Conclusion:

Although developed to suit clinical practice, patients report variance in the moment they receive the DA. Further investigation is needed to identify the optimal moment of introduction.  Many DA users seem to find confirmation of their initial preference. Follow-up measures have to indicate whether this confirmation also leads to lower levels of decisional conflict and less regret. The potential of the DA to support SDM is promising, with many patients indicating the DA helped asking questions and discussing the DA summary. However, two out of five men indicate low added value of the DA and may benefit more from a tailored approach.