A Tool to Aid Treatment Decisions in Prostate Cancer

Significant controversy in recent years over decisions on the pros and cons of watchful surveillance among prostate cancer patients has led researchers at the Thomas Jefferson University to develop an online decision-support tool. Created with the patient in mind, the Decision Counseling Program is particularly helpful for men diagnosed with localized, low-risk prostate cancer who may choose active treatment.

With shared decision making, a patient’s knowledge as well as perception of his or her disease has a significant bearing on the treatment plan. For the patient, survival is understandably the goal of treatment—however, lack of adequate understanding about their disease and the treatment options could lead to wrong choices. With this in mind, the researchers at Jefferson enrolled 30 men at a multidisciplinary clinic, who had been diagnosed with localized low-risk prostate cancer, in a trial to explore the influence of a decision support intervention.

The men filled out a survey prior to the intervention. Subsequently, they participated in a nurse-mediated online session on decision support that clarified their 2 treatment options: active surveillance (AS) and active treatment (AT). The session was followed by the men meeting with a clinician for shared decision making (SDM) and a follow-up survey in 30 days.

“The Decision Counseling Program is used by a trained nurse educator to help patients understand their options, figure out what things would make them favor one option over the other, and clarify the option they prefer,” first author of the study, Ronald Myers, PhD, said in an interview. The program “also produces a one-page summary that the patient and his physician can use to make a shared decision that makes the most sense,” he added.

The follow-up survey was an eye-opener and underscored the importance of raising patient awareness on treatments to help override misconceptions. Participants showed increased knowledge (P<.001), reduced decisional conflict (P<.001), and more favorable perceptions of AS (P = .001), the authors found. Importantly, a majority (25 of 30, 83%) of participants decided that AS would be their choice of care following this exercise.

The authors conclude that SDM prepared patients to make an informed decision and facilitated their choice of AS.

Reference

Myers RE, Leader AE, Censits JH, et al. Decision support and shared decision making about active surveillance versus active treatment among men diagnosed with low-risk prostate cancer: a pilot study [published online July 15, 2016]. J Cancer Educ.