PREFERENCES AND A DECISION AID IN PROSTATE CANCER TREATMENT DECISION MAKING

Friday, January 8, 2016
Foyer, 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:

To investigate which preference themes are important for choosing a treatment for localized prostate cancer (PC) and the role of a web based decision aid (DA) on treatment decision.

Method(s):

Between August 2014 and July 2015 we included newly diagnosed patients with low- or intermediate-risk PC and offered a web-based DA including Values Clarification Exercises (VCEs) to clarify patients’ preferences. Initial treatment preference was asked prior to DA use by asking ‘Before using this DA, what is your initial treatment preference?’, final treatment preference was indicated after DA use. 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):

We included 181 PC patients, 129 /175* (74%) patients indicated an initial (pre DA use) and 117/175 (67%) a final treatment preference. After DA use more patients chose for surgery (57/175 vs. 52/175 pre DA use) and fewer patients chose for brachytherapy (17/175 vs. 26/175 pre DA use) and external beam radiotherapy (5/175 vs. 13/175 pre DA use). Active surveillance percentages did not change. Men who chose for active surveillance after DA use preferred to avoid unnecessary treatment in 97% (37/38). For surgery 91% (52/57) valued tumour removal and 90% (51/57) was comforted by the thought that additional radiation would be possible. Brachytherapy patients valued incontinence worse than bowel complaints in 88 % (15/17). For external beam radiotherapy numbers were too low to draw conclusions. After DA use, 68% (88/129) stuck to their initial treatment preference and half of the patients who did not have an initial treatment preference were able to indicate a treatment preference (23/46).

Conclusion(s):

In contradiction with most DA studies preference for surgery increased after DA use and most indicated preference themes were ‘tumour removal’ and the possibility for additional radiotherapy after unsuccessful surgery. In the absence of an initial treatment preference the DA enables patients to form a treatment preference in 50% and it confirms initial treatment preference in almost 70% which may lower decisional conflict for these patients. Decisional conflict will be studied prospectively.

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