JOINT EVALUATION OF THREE PROSTATE CANCER TREATMENT DECISION AID TRIALS IN THE NETHERLANDS: RESULTS FROM THE JIPPA STUDY

Purpose: Decision aids (DAs) are instruments used to support shared decision-making between clinicians and patients. Dutch localized prostate cancer (Pca) treatment DAs were developed independently by three teams, consisting of a booklet-only, a hybrid (booklet + online) and an online-only DA (with values clarification exercises). Following a joint protocol, the DAs were evaluated in separate trials. Furthermore, the routine DA use in clinical practice was investigated.  

Methods: Half of all Dutch hospitals (44/90) participated in the trials. Almost 1,000 patients (M_age=66.0) were included, of which 654 patients used a DA. Patient questionnaires were filled out after treatment choice but before treatment start and included measures off patient participation, decisional conflict, knowledge, satisfaction with information, preparation for decision-making and perceived barriers and facilitators. Additional clinical data were obtained from the patients’ medical record and The Netherlands Cancer Registry. In total 100 clinicians (urologists and nurses) filled out an online survey to evaluate working with DAs. Analyses were performed using t-tests, ANOVA and chi-square tests.

Results: Each DA improved knowledge, satisfaction with information and preparation for decision-making, and lowered decisional conflict compared to the aggregated control group (all with p<.001). DA users indicated that more treatments were available and perceived a more active role in treatment decision-making, although effect sizes were small (d<0.2). DAs did not lead to stronger treatment preferences. Usability of each DA was evaluated positively by a majority of patients, though patients were less satisfied with the most extensive online-only DA. Patients preferred a paper to online versions. Optimal moment for receiving a DA lies close to diagnosis. A majority of patients (81%) consider the urologist as the most appropriate person to offer the DA. However, patients who received the DA from a nurse had less decisional conflict and more knowledge. Contrary to patients’ evaluations, clinicians’ evaluation did not differ between DAs. For all three DAs, implementation varied widely between hospitals. In case a DA was not offered, clinicians indicated they had forgotten or judged a patient was incapable or unwilling to use a DA.

Conclusions: Although DA formats varied, patients and clinicians evaluated all three DAs positively and all DAs were effective. The wide variation in DA uptake between hospitals will be addressed in a qualitative follow-up study.