This study aimed to explore the effects of a decision support intervention (DSI) and shared decision making (SDM) on knowledge, perceptions about treatment, and treatment choice among men diagnosed with localized low-risk prostate cancer (PCa). At a multidisciplinary clinic visit, 30 consenting men with localized low-risk PCa completed a baseline survey, had a nurse-mediated online DS session to clarify preference for active surveillance (AS) or active treatment (AT), and met with clinicians for SDM. Participants also completed a follow-up survey at 30 days. We assessed change in treatment knowledge, decisional conflict, and perceptions and identified predictors of AS. At follow-up, participants exhibited increased knowledge (p < 0.001), decreased decisional conflict (p < 0.001), and more favorable perceptions of AS (p = 0.001). Furthermore, 25 of the 30 participants (83 %) initiated AS. Increased family and clinician support predicted this choice (p < 0.001). DSI/SDM prepared patients to make an informed decision. Perceived support of the decision facilitated patient choice of AS.
Prostate cancer Active surveillance Shared decision making Decision support interventions
This project was funded, in part, under a grant with the Pennsylvania Department of Health (SAP No. 41000062221). The Department specifically disclaims responsibility for any analyses, interpretations, or conclusions.
Compliance with Ethical Standards
This study was approved by the Thomas Jefferson University Institutional Review Board.
American Cancer Society (2015) Cancer facts & figures 2015. American Cancer Society, Atlanta, GAGoogle Scholar
Welch HG, Albertsen PC (2009) Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986–2005. J Natl Cancer Inst 101:1325–3CrossRefPubMedPubMedCentralGoogle Scholar
Chou R, Croswell JM, Dana T et al (2011) Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 155:762–771CrossRefPubMedGoogle Scholar
Cooperberg MR, Carroll PR (2015) Trends in management for patients with localized prostate cancer, 1990–2013. JAMA 314:80–82CrossRefPubMedGoogle Scholar
Ritch CR, Grave AJ, Keegan KA et al (2015) Increasing use of observation among men at low risk for prostate cancer mortality. J Urol 193:801–806CrossRefPubMedGoogle Scholar
Weiner AB, Patel SB, Etzioni R et al (2015) National trends in the management of low and intermediate risk prostate cancer in the United States. J Urol 193:95–102CrossRefPubMedGoogle Scholar
Womble PR, Montie JE, Ye Z (2015) Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer. Eur Urol 67:44–50CrossRefPubMedGoogle Scholar
Volk RJ, McFall SL, Cantor SB et al (2014) ‘It’s not like you just had a heart attack’: decision making about active surveillance by men with localized prostate cancer. Psychooncology 23:467–472CrossRefPubMedGoogle Scholar
Anandadas CN, Clarke NW, Davidson SE et al (2011) Early prostate cancer—which treatment do men prefer and why? BJU Int 107:1762–1768CrossRefPubMedGoogle Scholar
Lin GA, Aaronson DS, Knight SJ et al (2009) Patient decision aids for prostate cancer treatment: a systematic review of the literature. CA Cancer J Clin 59:379–390CrossRefPubMedGoogle Scholar
Violette PD, Agoritsas T, Alexander P et al (2015) Decision aids for localized prostate cancer treatment choice: systematic review and meta-analysis. CA J Clin 65:239–251CrossRefGoogle Scholar
Stacey D, Légaré F, Col NF et al (2014) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 1, CD001431PubMedGoogle Scholar
Gomella LG, Lin J, Hoffman-Censits J et al (2010) Enhancing prostate cancer care through the multidisciplinary approach: a 15-year experience. J Oncol Pract 6:e5–e10CrossRefPubMedPubMedCentralGoogle Scholar
Vernon SW, Myers RE, Tilley BC (1997) Development and validation of an instrument to measure factors related to colorectal cancer screening adherence. Cancer Epidemiol Biomarkers Prev 6:825–832PubMedGoogle Scholar
Tiro JA, Vernon SW, Hyslop T et al (2005) Factorial validity and invariance of a survey measuring psychosocial correlates of colorectal cancer screening among African Americans and Caucasians. Cancer Epidemiol Biomarkers Prev 14:2855–2861CrossRefPubMedGoogle Scholar
Wilt TJ (2014) Management of low risk and low PSA prostate cancer: long term results from the Prostate Cancer Intervention versus Observation Trial. Recent Results Cancer Res 202:149–169CrossRefPubMedGoogle Scholar
Heidenreich BPJ, Bellmunt J et al (2013) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update, 2013. Euro Urol 65:124–137CrossRefGoogle Scholar
Hayes JH, Ollendorf DA, Pearson SD et al (2010) Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis. JAMA 304:2373–2380CrossRefPubMedPubMedCentralGoogle Scholar
Christie DR, Sharpley CF, Bitsika V (2015) Why do patients regret their prostate cancer treatment? A systematic review of regret after treatment for localized prostate cancer. Psych-Oncol 24:1002–1011CrossRefGoogle Scholar
Shappley WV, Kenfield SA, Kasperzyk JL et al (2009) Prospective study of determinants and outcomes of deferred treatment or watchful waiting among men with prostate cancer in a nationwide cohort. J Clin Oncol 27:4980–4985CrossRefPubMedPubMedCentralGoogle Scholar
National Comprehensive Cancer Network guidelines for prostate cancer (2015) Corrections to Version 1.2015 of the NCCN Guidelines for Prostate Cancer.Google Scholar
Chen RC, Rumble B, Loblaw DA et al. (2016) Active surveillance for the management of localized prostate cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol doi: 10.1200/JCO.2015.65.7759.