DOCTORS` INFLUENCE ON PATIENTS' TREATMENT CHOICE IN LOCALIZED PROSTATE CANCER

Saturday, January 9, 2016: 16:15
Kai Chong Tong Auditorium, G/F (Jockey Club School of Public Health and Primary Care Building at Prince of Wales Hospital)

Romy R.E.D. Lamers, MD1, Maarten Cuypers, MSc.2, Marieke de Vries, PhD2, Lonneke V. van de Poll-Franse, PhD3, J.L.H.R. Bosch, MD, PhD4 and Paul J.M. Kil, MD, PhD1, (1)St. Elisabeth Hospital, Tilburg, Netherlands, (2)Tilburg University, Tilburg, Netherlands, (3)Comprehensive Cancer Centre the Netherlands South, Eindhoven, Netherlands, (4)University Medical Center Utrecht, Utrecht, Netherlands
Purpose:

Despite the importance of shared decision making, doctors’ advice is rated as the most important factor influencing final treatment decision. Since it has been shown that patients and doctors differ in their preferences and trade-offs it is important to clarify the role of the doctor in the decision-making process. Therefore, our purpose was to investigate the influence of doctors` treatment preferences on patients’ treatment preferences in localized prostate cancer (PC) and to investigate the influence of a decision aid on their choice.

Method(s):

Between August 2014 and July 2015 we included 181 newly diagnosed patients with low- or intermediate-risk PC. All were offered a web-based Decision Aid (DA) to support treatment decision making. Initial treatment preference was asked prior to DA use by asking ‘Before using this DA, what is your initial treatment preference?’. Doctors treatment preference was obtained by a paper informed consent form for clinicians by asking ‘What is the most suitable treatment option for this patient according to you?’. This prospective study took place within an ongoing two-armed pragmatic Cluster Randomized Controlled Trial investigating the effects of a web based DA (Cuypers et. al, Trials 2015).

Result(s):

For 155 of 181 patients information about both doctors’ and patients’ preferences were available. Doctors indicated a specific preferred treatment option in 63% (98/155), patients in 74% (115/155). The most frequently indicated preferred treatment options by doctors were active surveillance (38%, 37/98) and surgery (37%, 36/98). In 62 % (61/98) patients’ initial treatment preference was in correspondence with their doctors treatment preference. When patients did not indicate a treatment preference after DA use, they eventually chose the treatment their doctor preferred.

Conclusion(s):

In 63%, doctors indicate a specific treatment preference for PC patients and in 62 % of these cases the patients’ treatment preference is in correspondence with the doctor’s preference. The preferred doctors’ opinion may have the highest influence on patients without a treatment preference after DA use. It is therefore highly recommended to involve patients in decision making and to stimulate their own decision making to avoid biased decision making by only following the doctors preference.

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