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Intervention Helps Prostate Cancer Patients Make Better Choices

A tool that aligned patient preferences with the advantages and disadvantages of prostate cancer treatments improved patient satisfaction with care, researchers reported.

From January 2014 through March 2015, 743 patients with localized prostate cancer were recruited and randomly assigned to receive Patient Preferences for Prostate Cancer Care (PreProCare) or usual care, according to Ravishankar Jayadevappa, PhD, of the University of Pennsylvania in Philadelphia, and colleagues.

For the general satisfaction subscale, improvement at 24 months from baseline was signi´Čücantly different between groups (P<0 .001), they reported in the Journal of Clinical Oncology

For the intervention group, mean scores at 24 months improved by 0.44 (SE, 0.06, P<0.001) from baseline, they added, noting that the use of PreProCare improved patient satisfaction with treatment decisions, and reduced regrets about those treatment decisions.

“The results speak for themselves,” commented Otis Brawley, MD, of Johns Hopkins University in Baltimore, to MedPage Today.

“These sorts of structured approaches make sure that things are actually covered in a conversation, and it doesn’t surprise me that patients are happier with their decisions when there is a regimented discussion that has gone on,” said Brawley, who was not involved in the study.

“And this is especially important in prostate cancer because there are so many different treatment options, or observation options, that are currently available,” added Brawley, former chief medical officer of the American Cancer Society.

Jayadevappa and colleagues pointed out that in patient-centered care — now one of the key goals in the U.S. healthcare system — “concordance between patient preferences and treatment attributes may help optimize outcomes.”

However, they also noted that there is little date supporting that conclusion when it comes to prostate cancer, adding that there “is a need for a comprehensive analysis of the effects of preference assessment on longitudinal changes in satisfaction with care, satisfaction with decision, decision regret, and treatment choice.”

For the multicenter, randomized controlled trial, the authors recruited 743 patients with localized prostate cancer, half of whom were assigned to received PreProCare and the other half usual care.

Patients in the PreProCare cohort completed a 30-minute, web-based assessment tool in which they were given a brief introduction to PreProCare, and completed a questionnaire ranking the attributes of prostate cancer treatments (from not important to extremely important). Based on those rankings, they were provided with choice scenarios (consisting of combinations of attributes), and then selected the preferred combination. Patients were encouraged to share the results of the PreProCare intervention with their provider.

Patients in the usual care group received standard educational material about prostate cancer treatments.

The primary outcome of the trial was satisfaction with care, while secondary outcomes included satisfaction with decision, decision regret, and treatment choice, with assessments performed at baseline, 3, 6, 12, and 24 months.

Patient satisfaction was assessed via an 18-item patient satisfaction questionnaire in which those items were consolidated into seven subscales — general satisfaction with care and six different aspects of care.

The authors reported that the improvement in the general satisfaction subscale at 24 months from baseline was equal to 0.5 standard deviation, and considered clinically significant.

Satisfaction with treatment decision scores improved in both groups, with the improvement more significant in the PreProCare group. And treatment decision regret scores declined in both groups, but the decline was greater in the PreProCare group.

As for treatment choice, among low-risk patients, a higher proportion of the PreProCare patients selected active surveillance (66%) versus the usual-care group (54%). Treatment choice was similar for intermediate-risk and high-risk patients.

“Our study demonstrates that in localized [prostate cancer], helping patients identify their own preferences using a structured, standardized, computer-based preference assessment tool may be a mechanism for enhancing patient-centered decision making and outcomes,” the authors concluded.

Study limitations included no data on cancer recurrence and complications among participants, and the authors did not measure the quality of patient-physician interactions post-intervention.

Brawley told MedPage Today that making decisions about active treatment or observation remains a quandary for men diagnosed with early stage prostate cancer.

“It is a hard decision, and I’ve had patients compare it to Russian roulette” he said. “The more you know, the more comfortable you are with the decisions you make. It will be easier to deal with side effects and risks of treatment, and the side effects and risks of observation, if you understand what those side effects and risks are.”

The study was supported by the Patient-Centered Outcomes Research Institute.

Jayadevappa disclosed no relevant relationships with industry. Co-authors disclosed multiple relevant relationships with industry.


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