Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid

Abstract

Trial NTR1334What's known on the subject? and What does the study add?• Many patients are eligible for more than one treatment option for prostate cancer. In usual care, urologists have a large influence on the treatment choice. Decision aids, providing balanced information on the pros and cons of different treatment options, improve the match between patient preferences and treatment received.• In men eligible for both surgery and external beam radiotherapy, treatment choice differed by hospital. Across the participating hospitals, the decision aid consistently led to fewer patients remaining undecided on their treatment preference and more patients choosing brachytherapy. Objectives• To examine the treatment choice for localized prostate cancer in selected men who were eligible for both prostatectomy and radiotherapy.• To examine whether increased patient participation, using a decision aid, affected the treatment choice. Patients and Methods• From 2008 to 2011, 240 patients with localized prostate cancer were enrolled from three separate hospitals.• They were selected to be eligible for both prostatectomy and external beam radiotherapy. Brachytherapy was a third option for about half of the patients.• In this randomized controlled trial, patients were randomized to a group which only discussed their treatment with their specialist (usual care group) and a group which received additional information from a decision aid presented by a researcher (decision aid group). The decision aid was based on a literature review.• Predictors of treatment choice were examined.

Patient driven care in the management of prostate cancer: analysis of the United States military healthcare system

“…Previous studies among men with prostate cancer have demonstrated patient preferences for various treatment options for prostate cancer (e.g. active surveillance, surgery, radiation, or hormonal therapy) [17–19], cosmetic results of different types of prostatectomies [20] and on functional outcomes (erectile function and continence) [21]. Our results expand on this pre-existing body of work, and demonstrate that patient preferences indeed induce a demand for greater utilization of healthcare services, which could feasibly impact the overall burden of disease.…”

A Systematic Literature Review of Shared Decision Making in Cancer Care (Preprint)

“…Eighteen unique DAs were identified across the 23 studies. The majority of studies reported on a single patient-clinician interaction (n=18, 78%); only three studies (13%) [38,59,72] reported more than one patientclinician interaction. In two studies (9%), [70,73] it was not possible to determine the number of patient-clinician interactions (Table 1).…”

“…[76] Qualitatively, as the number of SDM elements in each study increased, there was no corresponding increased likelihood of effectiveness (statistical significance) in terms of study outcomes (Table 3). Of note, two studies [61,72] were classified as highly effective, and both of those studies only assessed a single outcome: treatment decision differences between groups after exposure to a DA. In both studies, [61,72] exposure to a DA led to "better" treatment choice for participants from the clinician's perspective.…”

“…Of note, two studies [61,72] were classified as highly effective, and both of those studies only assessed a single outcome: treatment decision differences between groups after exposure to a DA. In both studies, [61,72] exposure to a DA led to "better" treatment choice for participants from the clinician's perspective. These included decreased use of adjuvant breast cancer therapy and increased use of brachytherapy.…”

The decision-making role of the patient in localised prostate cancer treatment

“…There has not been adequate evidence to suggest significant impact on patients' decision making (Violette, Agoritsas et al 2015). However, patient participation was found to be increased in the patient population provided with decision aids, as well as the likelihood of patients choosing brachytherapy (Lin, Aaronson et al 2009, van Tol-Geerdink, Willem Leer et al 2013). …”