A structured, standardized, computer-based preference assessment tool showed can enhance patient-centered decision making for patients with localized prostate cancer, a study published in the Journal of Clinical Oncology has shown.1
Patient-centered care involves applying evidence-based knowledge to care tailored to a patient’s unique characteristics, needs, and preferences. Although assessment of patient preferences is a central component, there is a dearth of evidence regarding whether patient preference assessment is associated with improved patient-centered outcomes, including risk-aligned treatment choice. Because patients with prostate cancer can be assigned to a number of different risk categories based on disease-related characteristics and have a variety of treatment options, the researchers chose this population of preference-sensitive patients to evaluate the tool.
The multicenter, randomized, controlled clinical trial (ClinicalTrials.gov Identifier: NCT02032550) compared a patient preference intervention (PreProCare) with usual care (standard educational material on treatments) in men with localized prostate cancer. Results showed significant improvements in satisfaction with care, a reduction in regrets, and alignment of risk category with treatment choice among men with localized prostate cancer.
In the study, 743 patients with localized prostate cancer were randomized to the intervention or usual care. The decision aid intervention consisted of a 3-part web-based tool: an introduction to the tool, ranking of treatment attributes from “not important” to “extremely important,” and review of treatment scenarios based on attribute rankings with patient choice of preferred treatments.2 After completing the preference assessment, participating patients had the option to obtain a printout of the 5 treatment attributes they most preferred to share with their healthcare provider.
The effectiveness of the PreProCare tool was evaluated using self-administered assessment tools including the Patient Satisfaction Questionnaire, the Satisfaction With Decision Scale, the Memorial Anxiety Scale for Prostate Cancer, and the Patient Trust-Wake Forest Physician Trust Scale. Study participants completed each tool at baseline (prior to the intervention) and at 3, 6, 12, and 24 months. In addition, data from medical records were abstracted for patient sociodemographic and clinical characteristics, and treatments administered. The primary outcome of the study was satisfaction with care; secondary outcomes were satisfaction with treatment decision, decision regret, and treatment choice.
Study participants were mostly white (82%), mean age 63.7 years, and most (63%) had an annual income of $75,000 or more. In the intervention arm, a clinically significant improvement in general satisfaction (P <.001) was observed compared with the usual care arm at 24 months. In addition, the proportion of participants reporting satisfaction with decision and no regret increased over time in the intervention group, and was significantly higher compared with the usual care group at 24 months (P <.05). Furthermore, a significantly higher proportion of participants in the intervention arm with low-risk disease were receiving active surveillance compared with the usual care arm (P <.001).
Limitations of this study include the low diversity with respect to patient race and the high income of study participants, which may limit the generalizability of study results.
These results demonstrate that helping patients identify their own preferences can be a mechanism for enhancing patient-centered decision making and improving outcomes.
1. Jayadevappa R, Chhatre S, Gallo JJ, et al. Patient-centered preference assessment to improve satisfaction with care among patients with localized prostate cancer: a randomized controlled trial [published online on March 12, 2019]. J Clin Oncol. doi: 10.1200/JCO.18.01091
2. Chhatre S, Jefferson A, Cook R, et al. Patient-centered recruitment and retention for a randomized controlled study. Trials. 2018;19(1):205.