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

Abstract

Treatment decision-making can be difficult and complex for patients with low-risk prostate cancer. To the authors' knowledge, there is no consensus regarding an optimal treatment strategy and the choice of therapy involves tradeoffs between differing harms and benefits that are sensitive to patient values. In such situations, patients are often asked to participate actively in the decision-making process, and high-quality decisions require a well-informed patient whose values and preferences have been taken into consideration. Prior studies have indicated that patients have poor knowledge and unrealistic expectations regarding treatment, and physician judgments concerning patient preferences are often inaccurate. Decision aids (DAs) have been developed to help inform patients with low-risk prostate cancer about treatment options and assist in the decision-making process; however, little is currently known regarding the effects of such programs in this population. Thirteen studies of DAs for patients with prostate cancer were reviewed and it was found that the use of DAs can improve knowledge, encourage more active patient involvement in decision-making, and decrease levels of anxiety and distress. The effect of DAs on treatment choice was less clear, although fewer patients chose surgery compared with historical controls, particularly in Europe. Further studies are needed to determine how best to implement DAs into practice, and whether they improve the consistency between patient preferences and treatment choice.

Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know?

“…And although many patients require time to process information about a cancer diagnosis before considering options, most feel pressure to make a decision about treatment soon after diagnosis (whether it results from system-level issues or pressure placed by the patient on him-or herself) [27,28]. As a result of the decision complexity, communication challenges, patients' heightened emotional state, and time pressure to make a decision, many patients unfortunately make decisions without fully understanding the options and associated risks and benefits [27][28][29]. In some cases, this lack of knowledge can lead to an underuse or overuse of cancer treatments [30,31].…”

Development of an Online, Patient-Centred Decision Aid for Patients with Oropharyngeal Cancer in the Transoral Robotic Surgery Era

“…Decision aids are available throughout the field of medicine, in both cancer and non-cancer populations (examples at https:// decisionaid.ohri.ca/AZlist.html). Within oncology, das have been reported in the context of cancer screening and in the selection of treatment in the adjuvant and definitive settings 9,[14][15][16] . The hallmarks of the cancer das include facilitating communication, aiding in the decision-making process, and enhancing patient satisfaction 9,10 .…”

Improving the Communication of Benefits and Harms of Treatment Strategies: Decision Aids for Localized Prostate Cancer Treatment Decisions

“…Another systematic review of decision aids for prostate cancer treatment identified 10 observational trials not included in the Cochrane review (30). These studies were generally quasi-experimental with pre-post design, though two used controls, one concurrent (31) and the other historical (32).…”