Abstract
BackgroundThe Personal Patient Profile-Prostate (P3P) is a web-based decision support system for men newly diagnosed with localized prostate cancer that has demonstrated efficacy in reducing decisional conflict. Our objective was to estimate willingness-to-pay (WTP) for men’s decisional preparation activities.MethodsIn a multicenter, randomized trial of P3P, usual care group participants received typical preparation for decision making plus referral to publicly-available, educational websites. Intervention group participants received the same, plus online P3P educational media specific to the user’s personal preferences and values, and a communication coaching component tailored to race\\ethnicity, age and language. WTP data were collected one week after physician consultation. An iterative bidding direct contingent valuation survey format was used, randomly assigning participants to high or low starting values (SV). Tobit models were used to explore associations between SV-adjusted WTP and age, education, marital and work-status, insurance, decision-control preference and decision-making stage.ResultsOf 392 participants enrolled, 141 P3P and 107 usual care (UC) provided a WTP value. Men were willing to pay a median $25 (IQR $10–100) for P3P in addition to usual care preparation materials. In the final multivariable tobit regression model, SV, marital status, stage of decision making and income were significantly associated with WTP for P3P. Decision control preference was considered marginally significant (p = 0.11). Men were WTP a median $30 (IQR $10–$200) for usual care material alone. In the final multivariable model, SV, education, and stage of decision making were significantly associated with WTP in usual care.ConclusionWTP was similar for UC and for the addition of P3P to UC decision preparation. The WTP values were associated with demographic and preference variables. Findings can help focus decision support on future patients who would benefit most: those without strong support systems, at earlier stages of decision making, and open to a shared-decision style.Trial registrationNCT NCT01844999. Registered May 3, 2013.
Highlights
The Personal Patient Profile-Prostate (P3P) is a web-based decision support system for men newly diagnosed with localized prostate cancer that has demonstrated efficacy in reducing decisional conflict
Not providing a WTP value was associated with being randomized to usual care (UC) (p = 0.001) and, regardless of study group, having high school or lower education (p = 0.047)
If they prefer to make shared rather than passive decisions is important. This valuation could mean that participants who were not yet ready to engage with a decision aid, had a more private decision-making style or found less value in decision aids. These WTP valuations of P3P can help to focus on future patients who would benefit most from decision aids: men not yet starting decision making, those without a partner/spouse to share in the decision process, and those open to shared decision making
Summary
The Personal Patient Profile-Prostate (P3P) is a web-based decision support system for men newly diagnosed with localized prostate cancer that has demonstrated efficacy in reducing decisional conflict. The use of decision aids to promote shared decision making is especially important in prostate cancer treatment decisions, a condition in which personal values and preference regarding risks of treatment side effects influence the patient’s choice [1,2,3]. The Personal Patient Profile-Prostate (P3P) is a web-based decision support system that has been shown to decrease decisional conflict in men newly diagnosed with localized prostate cancer [4, 5]. Despite evidence of the value of decisions aids, uptake in the United States remains low and economic value may be an important factor. For value-sensitive decisions there are often no right or wrong choices based purely on clinical evidence
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