CLINICIANS' EXPERIENCE OF WORKING WITH A PROSTATE CANCER TREATMENT DECISION AID COMPARED TO STANDARD INFORMATION ROUTINES

Purpose: Uptake of patient decision aids (DAs) in routine clinical care is low. To gain insight in underlying motivations, this study compared clinicians’ experiences with a prostate cancer (Pca) treatment DA to a control sample’s evaluation of standard information routines.

Method: Eighteen Dutch hospitals were randomized to implement an online Pca treatment DA (intervention arm) or to provide information as usual (control arm). 108 clinicians (urologists and nurses) from both study arms were invited to fill out an online questionnaire about the DA and information provision. Questionnaires were send a year after trial start, and if a minimum of 15 DAs per hospital were offered (intervention only). Response rate was 58%, equally distributed among both arms (30-33).

Result: Standard information was reported to consist of oral information (100%) and hospital specific materials (e.g. brochures; 90%). Half of the respondents reported additional materials being offered (e.g. websites or external brochures). Clinicians in the intervention arm offered 200 DAs to patients and supported DA content and usability, however only 20% of the clinicians indicated noticeable effects from using the DA (6/28). Sixty percent of clinicians in the control arm perceived that patients already receive too much information. Average satisfaction (1-10) with standard information was higher than satisfaction with the DA (8.1 vs. 7.8, p=0.03). Clinicians from both arms indicated offering a DA to patients should not exclusively be a task of an urologist, instead also nurses should be involved. Most clinicians in the intervention arm (25/28) indicated DA use did not increase consultation time, consistently, clinicians in the control arm also do not expect this (30/33). Only half of the clinicians would favor including offering DAs in treatment guidelines.

Conclusion: DAs are often added on top of standard information while we found that clinicians are already satisfied with standard information routines and feel patients receive too much information. Although clinicians were positive about the DA content and usability, noticeable effects were not reported often. Time is not expected nor perceived as a barrier for DA use. Moreover, to increase clinician support for DA uptake, developers should be challenged to reduce information load instead of offering DAs as an additional source. Also, nurses could play an important role in supporting DA use.