Study Examines Shared Decision-Making among Patients with Prostate Cancer

New Orleans—For men with prostate cancer, shared decision-making among the patient and the healthcare provider is often recommended, though poorly documented, as no study to date has recorded shared decision-making behaviors during a urologic consultation. Shared decision-making has been endorsed as a key component to improving the quality of decision-making in urology. A pilot feasibility study presented by Alan L. Kaplan, MD, and colleagues during a session at the AUA 2015 Annual Meeting sought to better understand this effort.

The researchers observed, quantified, and tested the effect of shared decision-making via recordings of 20 consultations with men with prostate cancer. They found that “measuring actual shared decision-making behaviors in a busy urology clinic is feasible.” This was the first study to measure actual shared decision-making in this setting.

The 20 study participants were recruited at two public hospitals prior to their cancer consultations, and all men received an educational brochure. The participants were also randomized to receive a computer-based decision support intervention prior to the consultation. The visits were audiotaped, and trained coders used the 12-item OPTION physician tool to measure observed shared decision-making behaviors.

The mean age of participants was 62 years. Ninety-five percent of men were non-white and 55% (n=11) were Spanish-speaking. Eighty percent of the participants had a high school education or less, and 90% had an income of $30,000 or less.

The coders measured Decisional Conflict Scale results, prostate cancer knowledge, and satisfaction scores after each visit. ANCOVA was used to control for baseline measures and to test the effect of high versus low shared decision-making by both the patient and provider.

The researchers found that OPTION scores for both physicians and patients were much higher than reported in any previous studies conducted in the primary care setting. Patients with lower OPTION scores exhibited higher decisional conflict at baseline, according to the study’s results. Decisional conflict decreased in both high and low OPTION score groups after consultation. The researchers found that participants who had higher shared decision-making behaviors had a greater reduction in the uncertainty subscale of the Decisional Conflict Scale (P=.02).

The researchers concluded, “Patients who exhibited more shared decision-making behaviors had reduced decisional uncertainly after consultation.” They noted that additional research is warranted to develop methods of engaging and activating patients in their decisions prior to consultation with a physician.

Source: Kaplan AL, Saucedo JD, Elwyn G, et al. Observing shared decision-making in the urology clinic: A pilot study among men with prostate cancer. Abstract of a presentation at the American Urological Association 2015 Annual Meeting, New Orleans, Louisiana, May 16, 2015.