Clinician Opinion Somewhat Favors Use of Shared Decision-making in Older Men with Metastatic Castration-Resistant Prostate Cancer
Older men with metastatic castration-resistant prostate cancer are often perceived as likely to play a passive role regarding care-related decisions.
A survey of Dutch multidisciplinary healthcare providers on the use of shared-decision making to facilitate treatment decisions in older men with metastatic castration-resistant prostate cancer (mCRPC) showed varying levels of agreement on the likely benefit of decision aids for these patients, as well as the need for clinician training to apply shared decision-making. The survey results were published in the Journal of Geriatric Oncology.
Older men with metastatic castration-resistant prostate cancer are often perceived as likely to play a passive role regarding decisions related to their care. This study was designed to evaluate the attitudes of members of the multidisciplinary team (eg, oncologists, urologists, oncology nurses) on engaging these patients in the treatment decision process.
For the study, the authors drafted a 4-part survey adapted from similar studies focused on different diseases. Part 1 assessed demographic information on the healthcare provider; part 2 queried the healthcare providers on their opinions on involving older patients with mCRPC in treatment decisions, patients' ability to evaluate the risks and benefits of particular treatments, and providers' training in the application of shared decision-making; part 3 specifically addressed the opinions of healthcare providers on the use of decision aids with older patients with mCRPC; and part 4 asked healthcare providers to make specific treatment recommendations through presentation of 4 hypothetical cases representative of this patient population.
Of the 82 urologists, 31 oncologists, and 57 oncology nurses surveyed, 63% of urologists, 74% of oncologists and 65% of oncology nurses agreed that treatment decisions should ideally be made together with the patient. Interestingly, although more than 50% of oncologists and urologists expressed the opinion that physicians are inadequately trained in shared decision-making, only 20% of oncology nurses agreed that oncology nurses were not well trained in this area. With respect to use of a decision aid in this patient population, 45% of urologists, 32% of oncologists, and 56% of oncology nurses were in favor of its use.
“Training healthcare providers on effective patient communication skills remains an imperative. Facilitating these conversations by making decision aid usage commonplace may better inform patients about treatments, associated risks, and expected prognosis, thus improving the decision-making process for both older patients and their healthcare providers,” wrote the authors.
de Angst IB, Kil PJM, Bangma CH, Takkenberg JJM.Should we involve patients more actively? Perspectives of the multidisciplinary team on shared-decision making for older patients with metastatic castration-resistant prostate cancer [published online January 10, 2019]. J Geriatr Oncol.doi: 10.1016/j.jgo.2018.12.003