Shared Decision-Making vs. Physician or Patient-Directed Decisions on Patient Quality of Life and Decision Satisfaction in Metastatic Prostate Cancer - Frank Schumacher
April 14, 2022
Frank Schumacher, MD Candidate, Northwestern University
Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts
ASCO GU 2022: Association of Functional Outcomes by Decision-Making Approach in Men with Metastatic Prostate Cancer
Prostate Cancer Screening and Shared Decision Making in the Veterans Health Administration - Stacy Loeb
ASCO GU 2020: Treatment Decision Making in Metastatic Prostate Cancer
Alicia Morgans: Hi, my name is Alicia Morgans, and I'm a GU Medical Oncologist at Dana-Farber Cancer Institute. I'm so excited to have here with me today, a friend and collaborator, Frank Schumacher, who is a third-year medical student at Northwestern University and a collaborator on the research team that I work with. Thank you so much for being here with me today.
Frank Schumacher: Absolutely. My pleasure.
Alicia Morgans: Wonderful. I wanted to talk with you a little bit about some of the research that you presented at GU ASCO 2022. Really, you had a beautiful poster, if I say so myself, I may be a little bit biased, but a wonderful poster that really outlined some decision making outcomes and information from patients with metastatic prostate cancer. Can you tell us a little bit about the project?
Frank Schumacher: Yeah, absolutely. We wanted to investigate some of the impacts that the roles that patients and physicians and how they interacted actually had on the outcomes that the patient experienced. We've discovered over time that the degree of input that patients have in their own decision making in medical decisions and all types of medical problems can actually have an impact on their outcome. So, we wanted to investigate that further in prostate cancer because that hadn't necessarily been done before.
Alicia Morgans: Absolutely. And it especially hadn't been done in patients with more advanced disease, which I think is important as we think about how we help them choose from the treatment options that they have at their disposal. How many patients did you enroll and assess in terms of their decision making practices?
Frank Schumacher: Yeah. We enrolled old about 100 patients over about 3 years, I believe we started in 2018 and through 2020. All these patients had metastatic prostate cancer, so as you mentioned, advanced disease, and we wanted to make sure that they were making an important decision during that visit as well.
Alicia Morgans: Wonderful. And as you understood how that decision came about, we really, I think, characterized it as decision locus of control. So was the patient directing the decision? Was the doctor directing this decision? Or was it shared? That was sort of what we thought about.
Frank Schumacher: Exactly, yeah.
Alicia Morgans: What was the outcome that you were looking to see if that impacted?
Frank Schumacher: Yeah. We wanted to explore, as you mentioned, those three buckets of patients and who is kind of directing the decision, and we wanted to see how that might impact, broadly, outcomes for the patient. So those were measured on a number of different domains, but we used a validated scale, EORTC Quality of Life Scale, to see physical functioning, emotional functioning, social functioning, as well as just general satisfaction with their decisions as well, and see what we could find with that.
Alicia Morgans: So did the way in which a decision was made, again, that decision locus of control, affect any of those outcomes?
Frank Schumacher: We did find a significant association. The main finding that we found was that in patients who had either a shared decision or a decision that the patient felt like were more in control of that decision, those patients actually had better physical functioning at 4 months post-decision compared to those patients who had more of a physician-directed decision.
Alicia Morgans: That's so interesting, I think, because to see that buy-in from the patient, whether the patient's really directing decision himself or whether that's a collaborative decision, seems to be associated with that patient maintaining best function on the back end and is really, really interesting.
Frank Schumacher: Yeah, absolutely. And I think it's a laudable goal to have shared decision making for patients. I think we kind of talk about that as providers. But it doesn't necessarily mean anything if it isn't associated with a functional better outcome for patients. So, that's kind of what we were hoping to see. And I think it's also interesting to see that it was specifically with physical functioning as well. It's kind of interesting. I think the decision satisfaction piece makes a little more sense intuitively, but I think it's interesting to start seeing that there's actually functional outcomes that are associated with this.
Alicia Morgans: I think that's a really great point. One thing that I've learned from the FDA is that physical functioning is actually one of the metrics that they use in terms of patient-reported outcomes as being one of the most important when they're thinking about the regulatory approval process. So knowing that there is some impact just by having that patient engage in the decision is really, I think, lends credence to that focus by the regulatory body on that particular outcome. That's really, really interesting. Well, what would you say to people who are watching and are thinking about how this might be impactful on their clinical practice?
Frank Schumacher: Yeah. I think this gives more evidence to lending more effort to having the discussion with your patients on what their goals of care might be. I know there are a lot of different treatment choices in metastatic prostate cancer, especially in advanced disease, so there's a lot of different things to weigh, especially from the patient perspective. So I think making sure to invest the time to truly understand their goals and making sure that they feel really empowered to make the decision for themself at the end of the day, with a lot of education from their provider. But I think if that's being done, then there's reason to believe that they might actually function better in the long-term as well.
Alicia Morgans: I could not agree more. So, investing the time by the provider gives us invested patients and really seems to have a meaningful impact on the way they function, at least in this study. Well, thank you so much for presenting this. We should also, of course, acknowledge the Department of Defense that funded this work. Very appreciative to them. I really appreciate your time and your expertise today.
Frank Schumacher: Thank you so much.