Prostate Cancer Decision Aids Use Low in the USA

Decision aids may be underused by physicians treating prostate cancer patients with localised disease

  • Date: 10 Mar 2015
  • Author: Lynda Williams, Senior medwireNews Reporter
  • Topic: Prostate Cancer

medwireNews: Only a third of radiation oncologists and urologists in the USA use decision aids (DAs) when counselling patients with clinically localised prostate cancer, suggest responses to a questionnaire.

The survey was completed by 45.1% of the 1422 physicians contacted between 2011 and 2012 by Simon Kim, from Case Western Reserve University in Cleveland, Ohio, USA, and co-workers.

The team defined DAs as “tools developed to support patients’ decision making by including evidence for all viable treatment options, a balanced presentation of the risks and benefits of those options, and clarifying patient values.”

Just 35.5% of the radiation oncologists and urologists reported using a DA in clinical practice.

In all, 16.5% of physicians said DAs were “very useful” and 67.9% said they were “somewhat useful”. Similarly, 9.2% and 59.2% of respondents were very or moderately confident that DAs improve treatment decisions, respectively.

Furthermore, 22.2% and 59.2% of the respondents stated they strongly or moderately believed that DAs are applicable to their patients, respectively, and 85.7% said they believed DAs helped their patients choose effective treatments.

Many physicians questioned whether the average patient would be able to process information from DAs, although respondents who reported using DAs routinely in clinical practice were less likely to strongly or moderately believe this was an issue than those who did not (25.1 vs 45.6%).

The researchers also highlight that physicians who used DAs were less likely to believe that their estimation of cancer risk was more accurate than a DA compared with those who did not (23.8 vs 41.5%).

“These findings are concerning in light of results from previous studies that have clearly indicated that physicians are biased and often do a poor job in estimating the risks of prostate cancer mortality and life expectancy”, the researchers comment in JAMA Internal Medicine.

Highlighting efforts to increase shared decision making (SDM) between clinicians and prostate cancer patients, the team suggests: “By engaging physicians in developing DAs that are user friendly, creating incentives for their use, and facilitating collaborations across specialty organizations, SDM may become a more integral part of treatment decision making for clinically localized prostate cancer.”

Michael Barry, from Harvard Medical School in Boston, Massachusetts, USA, discusses in an invited commentary the need for the development of DAs that can be personalised to reflect a patient’s clinical and information preferences.

“In the context of the prostate cancer treatment decisions, some men will care greatly about risks of erectile dysfunction, whereas others will not”, he writes.

“One-size-fits-all decision aids may be a good start, but they do not fully address men’s needs for information and decision support.”

References

Wang EH, Gross CP, Tilburt JC, et al. Shared decision making and use of decision aids for localised prostate cancer. Perceptions from radiation oncologists and urologists. JAMA Intern Med 2015; Advance online publication 9 March. doi:10.1001/jamainternmed.2015.63

Barry MJ. Resolving the decision aid paradox. JAMA Intern Med 2015; Advance online publication 9 March. doi:10.1001/jamainternmed.2015.72

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