AUA 2022: Preference Elicitation and Treatment Decision Making Among Men Diagnosed with Localized Prostate Cancer: Results from the Healium Trial

( In a podium presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Diefenbach presented results of the Healium trial assessing treatment decision making in men with localized prostate cancer. This is a disease space in which treatment decision-making is complex and highly influenced by patients’ personal preferences. However, these important personal preferences are rarely comprehensively assessed in the clinical encounter and, thus, are not fully incorporated in the treatment selection process. When patient preferences are not fully included in the decision making process, there is an increased likelihood of decisional conflict and decisional regret.

Healium was developed as a brief interactive tool to aid men diagnosed with localized prostate cancer in preference identification and medical decision-making. Healium can be completed in 10 minutes or less and focuses on treatment preferences.

In this study, the authors assessed Healium in a randomized controlled trial. To do so, they enrolled 281 men diagnosed with localized prostate cancer from two hospitals. Once enrolled, men were randomized to receive Healium or, matched for time and attention, the Healing Choices for men with prostate cancer, an established online education tool. In contrast to Healium which may take less than 10 minutes, Healing Choices’ content, can take several hours to explore. Notably, each of these programs were introduced prior to a consultation with the physician. The primary outcome was decisional conflict, assessed at baseline, at 6 weeks, and 3 months.

Among the 281 enrolled men, the average age was 64 years (SD=6.93), 25% were minority, 78% were married, and the vast majority (73.4%) had a bachelor’s degree or below. At baseline, mean decisional conflict was 36.06 (SD=28) for men randomized to Healium and 32.96 (SD=24.52) for men randomized to Healing Choices. These levels are consistent with moderate decisional conflict (range 0-100; 100 extreme conflicts).

At six weeks post consultation (with either Healium or Healing Choices), decisional conflict decreased significantly with both approaches: 7.13 (SD=15.26) for those who received Healium and 6.61 (SD=13.04) for those who received Healing Choices. There was no significant difference in this change between the two groups (p=0.068). Further, they found no differences in decisional conflict subscales by intervention type or any moderating effect of age, education, or race.

Thus, the authors concluded that software education programs such as Healium or Healing Choices can significantly decrease treatment decisional conflict among men diagnosed with prostate cancer. Healium is appealing given the short time it takes to complete and its effectiveness. Wider implementation of these tools is necessary for broad population-level benefit.

Presented by: Michael Diefenbach, PhD

Written by: Christopher J.D. Wallis, University of Toronto Twitter: @WallisCJD during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

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