The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: A multi-center randomized trial |
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| Authors: | Donna L. Berry Barbara Halpenny Fangxin Hong Seth Wolpin William B. Lober Kenneth J. Russell William J. Ellis Usha Govindarajulu Jaclyn Bosco B. Joyce Davison Gerald Bennett Martha K. Terris Andrea Barsevick Daniel W. Lin Claire C. Yang Greg Swanson |
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| Affiliation: | 1. Dana-Farber Cancer Institute, Phyllis F. Cantor Center, Boston, MA 02215, USA;2. Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Boston, MA 02215, USA;3. University of Washington, Biobehavioral Nursing and Health Systems, Seattle, WA 98195, USA;4. University of Washington, Biobehavioral Nursing and Health Systems, Medical Education and Biomedical Informatics, Seattle, WA 98195, USA;5. University of Washington, Department of Radiation Oncology, Seattle, WA 98195, USA;6. University of Washington, Department of Urology, Seattle, WA 98195, USA;7. Brigham and Women''s Hospital, Department of Medicine, Boston, MA 02215, USA;8. University of Saskatchewan, Saskatoon, Canada;9. Georgia Health Sciences University, College of Nursing, Charlie Norwood VA Medical Center, Research and Development Service Line, Augusta, GA 30904, USA;10. Charlie Norwood VA Medical Center, Division of Surgery, Urology Section; Georgia Health Sciences University, Department of Surgery, Section of Urology, Augusta, GA 30904, USA;11. Fox Chase Cancer Center, Philadelphia, PA 19111, USA;12. VA Puget Sound Healthcare System; University of Washington, Department of Urology, Seattle, WA 98195, USA;13. South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, Department of Radiation Oncology, San Antonio, TX 78229, USA |
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| Abstract: | ![]()
ObjectiveThe purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice.MethodsA randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored.ResultsA total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate ?3.61; (confidence interval, ?7.01, 0.22), and values clarity (estimate ?3.57; confidence interval (?5.85,?1.30). Borderline effect was seen for the total decisional conflict score (estimate ?1.75; confidence interval (?3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated.ConclusionThe Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences. |
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