Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variation

Men with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges of men's preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision aids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of two strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a) PtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use.

Guided by the Knowledge to Action Framework, this comparative case study will be conducted using administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in Ontario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized prostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation oncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each setting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will be determined from administrative data. Factors associated with receiving the PtDA will be explored using multivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean and standard deviation (men's decisional conflict) and frequency and proportions (practitioners consulted, uptake of treatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will be calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression. Factors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic analysis of interview transcripts.

Determining how to embed PtDAs effectively within clinical pathways for men with localized prostate cancer is essential. PtDAs have the potential to strengthen men's active role in making prostate cancer decisions, enhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers and knowledge users will use findings to improve current PtDA use and consider scaling-up implementation.

Implementation science : IS. 2016 Jul 02*** epublish ***

Dawn Stacey, Monica Taljaard, Jennifer Smylie, Laura Boland, Rodney H Breau, Meg Carley, Kunal Jana, Larry Peckford, Terry Blackmore, Marian Waldie, Robert Chi Wu, France Legare

School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5, Canada. ., Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada., Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada., Population Health, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada., Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada., Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada., Department of Surgery, Division of Urology, 537-750 Spadina Cr. E., Saskatoon, S7K 3H3, Canada., Prostate Cancer Canada Network, Ottawa, Canada., Quality and Continuous Improvement, Acute and Emergency Services Branch, Saskatchewan Ministry of Health, Regina, Canada., Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada., Postgraduate Medical Education, University of Ottawa, Ottawa, Canada., Research Centre CHU de Quebec-Universite Laval, Quebec, Canada.

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