A randomized trial of choice of treatment in prostate cancer: the effect of intervention on the treatment chosen

Abstract

OBJECTIVETo determine whether different approaches in the choice of treatment affect the treatment chosen by the patient for prostate cancer.PATIENTS AND METHODSWe conducted a randomized trial with 210 men who had a histologically confirmed diagnosis of prostate cancer in 1993–94 at four major hospitals in Finland. After obtaining informed consent the men were randomized either to an intervention arm, in which there was greater patient participation in the choice of treatment following a structured procedure, or a control arm in which the standard approach, i.e. a standardized treatment protocol, was used. The main outcome measure of the analysis was the primary treatment chosen for prostate cancer.RESULTSIn the enhanced participation arm patients not eligible for radical prostatectomy chose orchidectomy less frequently and favoured nonsurgical endocrine treatment than in the treatment protocol arm. Radical prostatectomy was the most commonly chosen treatment option in both arms among men with operable cancer. The way treatment options were presented affected the treatment chosen for prostate cancer.CONCLUSIONPatients with prostate cancer are willing and able to take an active role in making decisions. The preferences of patients with prostate cancer in the choice of treatment may differ from the priorities of the physicians.

Patient Decision Aids for Prostate Cancer Treatment: A Systematic Review of the Literature

“…32 Study quality was assessed for the 3 RCTs using the Jadad score. 29 The trial by Davison et al (published in 1997) 38 had a 2/6 rating (poor quality) and the trials by Auvinen et al 33 40 had a 3/6 rating (good quality).…”

“…Six DAs discussed "watchful waiting," surgical options, and radiation therapy (external beam radiation or brachytherapy). 33,[35][36][37]40,42 Four DAs also discussed hormonal or combination therapy. 33,37,42,43 One trial discussed surgery and radiation therapy only, 32 and 3 DAs described radiation therapy only.…”

“…Two trials tested interventions involving information exchange via in-person consultation with urologists and a multidisciplinary team. 32, 33 Davison and Degner tested an "empowerment" intervention, in which patients in the experimental group were coached through an information packet prior to consultation with the physician. 38 van Tol-Geerdink et al tested a written DA within the context of an interview.…”

“…The majority of the DAs were developed de novo; 2 trials used a DA developed by Holmes-Rovner et al 35,36 Kim et al used a DA produced by a pharmaceutical company. 37 Most DAs presented information in multiple formats, including written materials (8 trials) 30,31,[33][34][35][36][38][39][40] and multimedia presentations (8 trials), [35][36][37][38][40][41][42][43] and provided individualized information for patients based on their disease stage. Two trials tested interventions involving information exchange via in-person consultation with urologists and a multidisciplinary team.…”

“…[30][31][32][33][34][35][36][37][38][39][40][41][42][43] The DAs were delivered in 4 settings: hospitals (4 studies), physician's offices (1 study), patient education centers (4 studies), and nonmedical settings such as home or research office (4 studies). Participants were recruited from academic and community settings.…”