Bringing Men Into the Conversation: Shared Decision Making and Effects on Quality of Life in Advanced Prostate Cancer

UroToday (Truckee, CA): Announcing a new clinical trial: Shared decision making—in which both the doctor and patient collaborate on treatment decisions—is considered state of the art counseling in prostate and other cancers, according to the Institute of Medicine and the American Urological Association. Shared decision making is particularly important in metastatic castration-resistant prostate cancer (mCRPC), since choosing among available therapies can be a complex process. 

Multiple studies demonstrate that patients benefit from engaging in shared decision making, with improved satisfaction and confidence in their treatments, increased knowledge of their disease, and greater engagement with their treatment regimens. It is hypothesized that men with metastatic prostate cancer who take part in shared decision making may be more adherent to their treatments if they engage in a shared decision-making process, particularly with oral therapies for mCRPC. Shared decision-making may also increase patients’ willingness to adhere to recommendations regarding management of side effects from chemotherapy or radium-223.1,2,3

To assess the use of shared decision-making in the setting of treatment decisions for metastatic prostate cancer, we are completing a clinical trial funded by the Department of Defense. The study will investigate whether clinicians, patients, or both, are driving clinical decisions, and whether patients want to share in decision making with their healthcare providers. We will also assess quality of life and decision satisfaction in patients who participated in shared decision making, and compare these outcomes with those of men who completely directed treatment (patient-directed decision-making) and those whose doctor directed treatment without significant input from the patient (physician-directed decision-making). 

The shared decision making study, which opened in December 2016, will enroll 150 men with metastatic prostate cancer who are treated in Urology and Medical Oncology clinics at Vanderbilt University and Northwestern University. Participants must have a diagnosis of metastatic prostate cancer, and have made a decision in a clinic visit at the time of enrollment. Men complete surveys at baseline, 2 and 4 months to answer questions about how decisions were made in their clinic visit, and how they would prefer for decisions to be made.  Caregivers and providers are also surveyed to assess their perceptions of how the same treatment decision was made.

This study takes place over 3 years.  At the conclusion, we will be able to report how patients, providers and clinicians perceive treatment decisions were made in clinic, and how they prefer for them to be made.  We will also report whether shared decision making was associated with improved quality of life and decision satisfaction when compared with physician-controlled or patient-controlled decisions. Understanding the decision making process will allow us to identify aspects of decision making that may be targeted for improvement with decision tools or other interventions.

Written by: Alicia Morgans, MD, MPH

Alicia Morgans, MD, MPH is the Assistant Professor of medicine in the Division of Hematology/Oncology at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee. She specializes in the treatment of genitourinary malignancies, including cancers of the prostate, bladder and testis (germ cell) and penis. Dr. Morgans’ research focus is on complications of prostate cancer survivorship and treatment decision making in advanced prostate cancer.

  1. Makarov DV, Dhrouser K, Gore JL, et al. AUA White paper on implementation of shared decision making into urological practice. Urol Pract. 2016; 3 (5): 355-363. 
  2. Politi MC, Studts JL, Hayslip JW. Shared decision making in oncology practice: What do oncologists need to know. Oncologist. 2012; 17: 91-100.  
  3. Degner LF, Kristjanson LJ, Bowman D, et al. Information needs and decisional preferences in women with breast cancer. JAMA. 1997; 277: 145-1492. 
  4. Holmes-Rovner M, Kroll J, Schmitt N, et al. Patient satisfaction with health care decisions: The Satisfaction with Decision scale. Med Dec Making. 1996; 16: 58-64.

Additional reading: AUA White Paper on Implementation of Shared Decision Making into Urological Practice