Integrating patient preferences into treatment decisions for men with prostate cancer at the point of care.

Men with clinically localized prostate cancer face an archetypal "preference sensitive" treatment decision. A shared decision-making process incorporating patient values and preferences is paramount. We evaluated the benefit of a novel decision-making application, and investigated associations between patient preferences and treatment choice.

We utilized a novel, web-based application that provides education, preference measurement, and personalized decision analysis for newly diagnosed prostate cancer patients. Preferences are measured using conjoint analysis. The application ranks treatment options according to their "fit" (expected value) based on clinical factors and personal preferences and serves as the basis for shared decision-making during consultation. We administered the Decisional Conflict Scale before and after completion of the application. Additionally, we compared post-visit perceptions of shared decision-making between a baseline "usual care" cohort and a cohort seen after the application was integrated into clinical practice.

109 men completed the application prior to their consultation and had decisional conflict measured before and after use. Overall decisional conflict decreased by 37% (p<0.0001). Analysis of the decisional conflict subscales revealed statistically significant improvements in all five domains Patients completing the decision-making application (n=33) felt more included in (88% vs 57%, p=0.01) and jointly responsible for (94% vs 52%, p<0.0001) the decision about further treatment compared to those receiving usual care (n=24). More patients who completed the application strongly agreed that different treatment options were discussed (94% v 74%, p=0.02).

Implementation of this web-based intervention was associated with decreased decisional conflict and enhanced elements of shared decision-making.

The Journal of urology. 2016 Jun 23 [Epub ahead of print]

David C Johnson, Dana E Mueller, Allison M Deal, Mary W Dunn, Angela B Smith, Michael E Woods, Eric M Wallen, Raj S Pruthi, Matthew E Nielsen

Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina., Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

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