Shared decision making and use of decision aids for localized prostate cancer: Perceptions from radiation oncologists and urologists - Abstract

Importance: The current attitudes of prostate cancer specialists toward decision aids and their use in clinical practice to facilitate shared decision making are poorly understood.

Objective: To assess attitudes toward decision aids and their dissemination in clinical practice.

Design, Setting, and Participants: A survey was mailed to a national random sample of 1422 specialists (711 radiation oncologists and 711 urologists) in the United States from November 1, 2011, through April 30, 2012.

Main Outcomes and Measures: Respondents were asked about familiarity, perceptions, and use of decision aids for clinically localized prostate cancer and trust in various professional societies in developing decision aids. The Pearson χ2 test was used to test for bivariate associations between physician characteristics and outcomes.

Results: Similar response rates were observed for radiation oncologists and urologists (44.0% vs 46.1%; P = .46). Although most respondents had some familiarity with decision aids, only 35.5% currently use a decision aid in clinic practice. The most commonly cited barriers to decision aid use included the perception that their ability to estimate the risk of recurrence was superior to that of decision aids (7.7% in those not using decision aids and 26.2% in those using decision aids; P < .001) and the concern that patients could not process information from a decision aid (7.6% in those not using decision aids and 23.7% in those using decision aids; P < .001). In assessing trust in decision aids established by various professional medical societies, specialists consistently reported trust in favor of their respective organizations, with 9.2% being very confident and 59.2% being moderately confident (P = .01).

Conclusions and Relevance: Use of decision aids among specialists treating patients with prostate cancer is relatively low. Efforts to address barriers to clinical implementation of decision aids may facilitate greater shared decision making for patients diagnosed as having prostate cancer.

Written by:
Wang EH, Gross CP, Tilburt JC, Yu JB, Nguyen PL, Smaldone MC, Shah ND, Abouassally R, Sun M, Kim SP   Are you the author?
School of Medicine, Yale University, New Haven, Connecticut
Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, Connecticut
Department of Medicine, Yale University, New Haven, Connecticut
Department of Medicine, Mayo Clinic, Rochester, Minnesota
Bioethics Research Unit, Mayo Clinic, Rochester, Minnesota
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, Connecticut
Department of Radiation Oncology, Yale University, New Haven, Connecticut
Harvard University Medical School, Brigham and Women's Hospital, Boston, Massachusetts
Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
Department of Medicine, Mayo Clinic, Rochester, Minnesota
Division of Health Policy and Research, Mayo Clinic, Rochester, Minnesota
Urology Institute, Case Western Reserve University School of Medicine, University Hospital Case Medical Center, Cleveland, Ohio
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, Connecticut
Urology Institute, Case Western Reserve University School of Medicine, University Hospital Case Medical Center, Cleveland, Ohio
Center for Health Care Quality and Outcomes, University Hospital Case Medical Center, Cleveland, Ohio

Reference: JAMA Intern Med. 2015 Mar 9. (Epub ahead of print)
doi: 10.1001/jamainternmed.2015.63


PubMed Abstract
PMID: 25751604

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