The Impact of Within-Consultation and Pre-Consultation Decision Aids for Localized Prostate Cancer on Patient Knowledge: Results of a Patient-Level Randomized Trial.

To evaluate the role of timing (either before or during initial consultation) on the effectiveness of DAs to support shared decision making (SDM) in a minority-enriched sample of patients with localized prostate cancer using a patient-level randomized controlled trial design.

We conducted a 3-arm, patient-level-randomized trial in urology and radiation oncology practices in Ohio, South Dakota, and Alaska, testing the effect of pre-consultation and within-consultation DAs on patient knowledge elements deemed essential to make treatment decisions about localized prostate cancer, all measured immediately following the initial urology consultation using a 12-item Prostate Cancer Treatment Questionnaire (score range 0 [no questions correct] to 1 [all questions correct]), compared to usual care (no DAs).

Between 2017 and 2018, 103 patients - including 16 Black/African American and 17 American Indian or Alaska Native men - were enrolled and randomly assigned to receive usual care (n=33) or usual care and a DA before (n=37) or during (n=33) the consultation. After adjusting for baseline characteristics, there were no statistically significant proportional score differences in patient knowledge between the pre-consultation DA arm (0.06 knowledge change, 95% CI -0.02-0.12, p=0.1) or the within-consultation DA arm (0.04 knowledge change, 95% CI -0.03-0.11, p=0.3) and usual care.

In this trial oversampling minority men with localized prostate cancer, DAs presented at different times relative to the specialist consultation showed no improvement in patient knowledge above usual care.

Urology. 2023 Mar 08 [Epub ahead of print]

Daniel D Joyce, Jon C Tilburt, Joel E Pacyna, Kristin Cina, Daniel G Petereit, Kathryn R Koller, Christie A Flanagan, Barbara Stillwater, Mariam Miller, Judith S Kaur, Elizabeth Peil, David Zahrieh, Amylou C Dueck, Victor M Montori, Dominick L Frosch, Robert J Volk, Simon P Kim

Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: ., Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN. Electronic address: ., Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN. Electronic address: ., Walking Forward Avera Health, Division of Research, Rapid City, SD; Alaska Native Tribal Health Consortium Research Services, Anchorage, AK. Electronic address: ., Cancer Care Institute at Monument Health, Rapid City, SD; Walking Forward Avera Health, Division of Research, Rapid City, SD. Electronic address: ., Alaska Native Tribal Health Consortium Research Services, Anchorage, AK. Electronic address: ., Alaska Native Tribal Health Consortium Research Services, Anchorage, AK; Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK. Electronic address: ., Alaska Native Tribal Health Consortium Research Services, Anchorage, AK. Electronic address: ., Department of Urology, Alaska Native Medical Center, Anchorage, AK., Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL. Electronic address: ., Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN and Ultragenyx Pharmaceutical, Novato, CA. Electronic address: ., Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN and Ultragenyx Pharmaceutical, Novato, CA. Electronic address: ., Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, AZ. Electronic address: ., Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN. Electronic address: ., Health Science Diligence Advisors, LLC, Redwood City, CA.. Electronic address: ., Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: ., Division of Urology, University of Colorado Anschutz Medical Center, University of Colorado, Aurora, CO. Electronic address: .