Evaluating a Decision Aid for Patients with Localized Prostate Cancer in Clinical Practice

Abstract

Aim: The aim of the study was to evaluate the usefulness of a decision aid regarding treatment options for patients with early-stage localized prostate cancer. Methods: 50 patients with newly diagnosed localized prostate cancer received the decision aid and were interviewed twice: before the decision-making consultation with the physicians and before treatment or, in case of watchful waiting, before the follow-up consultation. The physicians (radiation oncologists and urologists) were interviewed after the consultation. Results: The patients became more active partners in the decision-making process: They were better prepared for the consultation, asked more direct information, and were able to make a more deliberative choice. Generally, the use of the decision aid improved the quality of the consultation and resulted in a treatment decision agreed upon by both parties. Sometimes the consultation turned out to be more time-consuming. The decision aid did not only improve the patient-physician interaction but also helped patients to discuss the disease with their partner and family members. Conclusion: The use of the decision aid has a positive impact on the consultation and the decision-making process. The policy of involving patients more actively in the decision process should be further implemented in daily practice.

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

“…[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.…”

“…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.…”

“…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.…”

“…[35][36][37][38][39][40][41][42][43] Four trials referred patients to a patient education center to view the DAs. [38][39][40]43 Four studies incorporated the DA into the physician visit.…”

“…Isebaert et al found that 82% of physicians believed that DAs had a positive influence on the consultation and decision-making process. 35 The improvement in the decision-making process manifested in 3 ways: (1) patients were more prepared for the consultation, allowing more focus on the patients' values and preferences; (2) patients were better able to formulate their own preferences; and (3) DAs helped patients discuss the disease and treatment options with family members. A minority of physicians (18%) believed that DAs complicated the decision-making process, particularly in patients with low health literacy.…”