Using an online decision-support tool led to most men with low-risk prostate cancer choosing active surveillance with less conflict about their decision. In general, although most men with localized, low-risk prostate cancer are more likely to die of causes other than this cancer, most men with this diagnosis choose active treatment over active surveillance.1
“The Decision Counseling Program© is used by a trained nurse educator to help patients understand their options, figure out what things would make them favor one option over the other, and clarify the option they prefer,” explained Ronald Myers, PhD, professor of medical oncology and researcher at the Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, and first author of the study.
“The Decision Counseling Program also produces a one-page summary that the patient and his physician can use to make a shared decision that makes the most sense.”
The Decision Counseling Program is a new type of patient decision aid. It differs from previous decision aids in that a nurse educator uses the program not only to provide information about options, but also to identify and weigh the importance of things that matter to the patient (eg, worry about treatment side effects, concern about developing aggressive cancer). Moreover, the program clarifies the patient’s preferred option and sets the stage for the patient and physician to make a well-informed choice.
“The power in the approach is that it gives the patient time to consider the options, put personal thoughts and concerns on the table, and have a voice in the decision making process,” said corresponding author Amy Leader DrPH, MPH, assistant professor of medical oncology and researcher at the Sidney Kimmel Cancer Center at Jefferson.
The study involved 30 patients with localized, low-risk prostate cancer who were candidates for active surveillance. Participating in this program led them to have a higher level of knowledge about their treatment options, report feeling less conflicted about the treatment decision, and have more favorable perceptions of active surveillance than they did at the outset of the study. Ultimately, 25 participants (83%) decided to initiate active surveillance, a rate much higher than typically observed in clinical practice.
1. Myers RE, Leader AE, Censits JH, et al. Decision support and shared decision making about active surveillance versus active treatment among men diagnosed with low-risk prostate cancer: a pilot study. J Cancer Educ. 2016 Jul 15. doi: 10.1007/s13187-016-1073-7. [Epub ahead of print]