Objective: Metastatic prostate cancer (mPCa) patients often make complicated treatment decisions, yet decision aids to facilitate shared decision-making for mPCa are uncommon. To inform the development of patient-centered mPCa decision aids, we examined what mPCa survivors considered most important when making treatment decisions. Methods: Using an exploratory sequential approach, we conducted three focus groups with 14 advanced prostate cancer survivors (n=5, n=3, n=6 in each group) to identify considerations for making treatment decisions. Focus groups were audio-recorded and transcribed, and we identified qualitative themes. We then developed a quantitative survey to assess the importance of each theme and administered the survey to mPCa survivors (N=100). We used relative frequencies to determine the most strongly endorsed items and chi-squared and Fisher's exact tests to assess associations with participant characteristics. Results: Focus groups yielded 11 themes, and the resulting survey included 20 items. The most strongly endorsed mPCa treatment considerations were: relying on physician's treatment recommendations (79% strongly agree); wanting to feel well enough to spend quality time with loved ones (72% strongly agree); the importance of dying in a manner consistent with one's wishes (70% strongly agree); hoping to eliminate cancer completely (68% strongly agree); and optimizing treatment efficacy (65% strongly agree). Age, race, marital status, employment status, and self-reported health were related to how strongly men endorsed various considerations for mPCa treatment decision-making. Conclusion: We identified multiple considerations that mPCa survivors appraised when making treatment decisions. These data may inform the development of patient-centered decision aids for mPCa.
BackgroundShared decision-making (SDM) for metastatic prostate cancer (mPC) engages patients in the decisionmaking process and may be associated with better outcomes relative to physician-or patient-directed decision-making. We assessed the association between decision locus of control (DLOC) and patientreported quality of life (QOL), functional outcomes, and decision satisfaction among mPC patients. MethodsAfter a clinic visit in which a treatment decision was made (baseline), mPC patients completed DLOC and QOL surveys. QOL was re-assessed at 2-and 4-months post-baseline. Mean scores for each QOL dimension (physical, emotional, cognitive, social, and role functioning) were compared by DLOC group using mixed effects models. Patient preferences for DLOC and provider communication techniques were similarly collected via survey. ResultsMedian age of participants (N = 101) was 69 years (range: 49-92); most were White (80%) and married (82%). 62% reported using SDM. At baseline, there were no differences in QOL dimensions between DLOC groups. At 4 months, patient-directed (p = 0.01) and SDM (p = 0.03) were associated with better physical functioning than physician-directed decision-making, and there was a trend toward greater decision satisfaction among patients who reported patient-directed (p = 0.06) or SDM (p = 0.10). SDM was the most reported preferred DLOC. ConclusionmPC patients reporting SDM had better physical functioning and a trend toward greater decision satisfaction at 4 months than physician-or patient-directed decision-making, suggesting measurable bene t from patient involvement in decision-making. Future investigations of these associations in larger, more diverse populations can further clarify these previously unmeasured bene ts of patient engagement in treatment decisions.Recent advances have created a multitude of treatment options, each with a unique set of bene ts and side effects. To date, there have been no direct comparisons of the various treatment options for mPC. This suggests differential bene t in terms of disease control, making treatment decision-making a complicated process for providers and patients. Thus, treatment decisions commonly depend on physician preferences and experience. An individualized approach to treatment decisions is preferred based on e cacy, as well as patient preferences, priorities, potential side effects, follow-up requirements, and cost of care. [2] This approach may be facilitated by shared decision-making (SDM) among patients, physicians, and caregivers, which has been identi ed by the National Academy of Medicine, the American Urological Association, and others as a priority method to improve the quality of cancer care in the US through patient engagement and autonomy.Decision-making preferences are highly individualized and vary widely among cancer patients, with patients reporting heterogeneous preferences for decision-making roles. [3][4][5][6] The extent that decisionmaking roles have impacted patient functional outcomes and decision satisfaction in mPC ...
78 Background: Multiple treatments with similar efficacy exist for mPC resulting in multifaceted treatment choices. Shared decision-making (SDM) engages patients and may be associated with superior outcomes in men with prostate cancer. We assessed the association of decision locus of control (DLOC) (SDM vs. physician- or patient-directed decisions) and measures of patient quality of life (QOL), including patient reported functional outcomes, and decision satisfaction. Methods: Patients completed surveys of decision-making practices after a clinic visit in which a decision occurred. Patients also completed the EORTC QLQ-C30 QOL instrument at baseline (time of decision), and 2- and 4-months. Scores for each QOL dimension and pain were calculated for each time point, and the least-squared means were compared among DLOC groups to evaluate for associations using a mixed effects model. Results: 101 patients participated, with median age of 69 years [range: 49-92]. Most patients were white (80%) and married (82%). A majority of patients reported experiencing SDM in the clinic visit assessed (63, 62%). At baseline, there was no significant difference in patient reported QOL dimensions among DLOC groups, but patients reporting physician-directed decisions reported significantly greater baseline pain than the SDM group (Table). At 4 months, patient reported physical functioning was superior among patients reporting patient-directed (p=0.005) or SDM (p=0.03) than those who reported physician-directed decision-making. There was a trend toward greater decision satisfaction among patients who reported patient-directed (p=0.06) or SDM (p=0.10) at 4-months compared to men reporting physician-directed decision-making. There were no differences at 4 months for social, emotional, cognitive, or role functioning between DLOC groups. Conclusions: Patients who reported greater control during treatment decisions had superior physical functioning and a trend toward greater decision satisfaction at 4 months compared with patients reporting physician-directed decisions, suggesting measurable domains of benefit from involvement in the decision-making process. Continued research evaluating the association between physical and psychological outcomes and DLOC is needed, including larger studies within more diverse populations.[Table: see text]
Background Shared decision-making (SDM) for metastatic prostate cancer (mPC) engages patients in the decision-making process and may be associated with better outcomes relative to physician- or patient-directed decision-making. We assessed the association between decision locus of control (DLOC) and patient-reported quality of life (QOL), functional outcomes, and decision satisfaction among mPC patients. Methods After a clinic visit in which a treatment decision was made (baseline), mPC patients completed DLOC and QOL surveys. QOL was re-assessed at 2- and 4-months post-baseline. Mean scores for each QOL dimension (physical, emotional, cognitive, social, and role functioning) were compared by DLOC group using mixed effects models. Patient preferences for DLOC and provider communication techniques were similarly collected via survey. Results Median age of participants (N = 101) was 69 years (range: 49–92); most were White (80%) and married (82%). 62% reported using SDM. At baseline, there were no differences in QOL dimensions between DLOC groups. At 4 months, patient-directed (p = 0.01) and SDM (p = 0.03) were associated with better physical functioning than physician-directed decision-making, and there was a trend toward greater decision satisfaction among patients who reported patient-directed (p = 0.06) or SDM (p = 0.10). SDM was the most reported preferred DLOC. Conclusion mPC patients reporting SDM had better physical functioning and a trend toward greater decision satisfaction at 4 months than physician- or patient-directed decision-making, suggesting measurable benefit from patient involvement in decision-making. Future investigations of these associations in larger, more diverse populations can further clarify these previously unmeasured benefits of patient engagement in treatment decisions.
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