Preference Elicitation and Treatment Decision-Making Among Men Diagnosed With Prostate Cancer: Randomized Controlled Trial Results of Healium (Preprint)

Abstract

BACKGROUND Elicitation of patients’ preferences is an integral part of shared decision making, the recommended approach for prostate cancer decision making. However, existing decision aids for this population do not specifically focus on patients’ preferences. Healium is a brief interactive web-based decision aid that aims to elicit patient’s treatment preferences and is designed for a low health literate population. OBJECTIVE This study used a randomized controlled trial to evaluate whether Healium (designed to target preference elicitation) is as efficacious as Healing Choices (a comprehensive education and decision tool) in improving outcomes for decision-making and emotional quality of life. METHODS Patients diagnosed with localized prostate cancer who had not yet made a treatment decision were randomly assigned to the brief Healium intervention or Healing Choices, an extensive decision aid previously developed by our group that serves as a virtual information center on prostate cancer diagnosis and treatment. Assessments were completed at baseline, 6-weeks and 3-months post-baseline, and included decisional outcomes (decisional conflict, satisfaction with decision, preparation for decision-making), and emotional quality of life (anxiety/tension and depression), along with demographics, comorbidities, and health literacy. RESULTS N = 327 individuals consented to participate in the study (171 were randomized to the Healium intervention arm and 156 were randomized to Healing Choices). The majority of the sample was non-Hispanic (96%), White (76%), married (78.4%), and had an average age of 62.4 years old (SD = 6.9). Within both arms, there was a significant decrease in decisional conflict from baseline to 6-weeks post baseline (Healium, P = <.001; Healing Choices, P = <.001), and a significant increase in satisfaction with one’s decision from 6 weeks to 3 months (Healium, P = .04; Healing Choices, P = .01). Within both arms, anxiety/tension (Healium, P = .23; Healing Choices, P = .27) and depression (Healium, P = .001; Healing Choices, P = <.001) decreased from baseline to 6-weeks, but only in the case of depression was the decrease statistically significant. CONCLUSIONS Healium, our brief decision aid focusing on treatment preference elicitation, is as successful in reducing decisional conflict as our previously tested comprehensive decision aid, Healing Choices, and has the added benefit of brevity and the potential for integration into the physician consultation and electronic medical record. CLINICALTRIAL n/a