Abstract
BackgroundMen with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges of men’s preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision aids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of two strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a) PtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use.Methods/designGuided by the Knowledge to Action Framework, this comparative case study will be conducted using administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in Ontario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized prostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation oncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each setting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will be determined from administrative data. Factors associated with receiving the PtDA will be explored using multivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean and standard deviation (men’s decisional conflict) and frequency and proportions (practitioners consulted, uptake of treatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will be calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression. Factors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic analysis of interview transcripts.DiscussionDetermining how to embed PtDAs effectively within clinical pathways for men with localized prostate cancer is essential. PtDAs have the potential to strengthen men’s active role in making prostate cancer decisions, enhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers and knowledge users will use findings to improve current PtDA use and consider scaling-up implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0451-1) contains supplementary material, which is available to authorized users.
Highlights
Men with localized prostate cancer often have unrealistic expectations
Our study aims to close the gap between what is currently known about patient decision aid (PtDA) from research studies and what is done with PtDAs when they are implemented in routine clinical practice
We will measure outcomes on patients, practitioners, and the healthcare system to ensure findings are consistent with benefits of PtDAs reported in randomized controlled trials of PtDAs without unintended consequences
Summary
Our deliverables are findings on the actual use of PtDAs for men with localized prostate cancer using two different implementation approaches in two different healthcare systems over a 2-year period. Our study results will advance knowledge about implementation of PtDA into clinical practice These findings can be used by knowledge users on our team for making decisions about improving implementation of PtDAs and scaling up their use with patients having prostate cancer or other cancers. Health policy documents in Saskatchewan [50], Ontario [51], and in other countries (e.g., USA, UK, Australia, Germany) call for a “patient first” approach to healthcare that can be improved by patients using PtDAs and making decisions with their practitioner, creating demand for evidence on sustainable PtDA implementation approaches that our study will provide. Our team is in a supportive research environment, has established collaborations with necessary expertise to conduct the proposed study, and can transfer findings to inform health policy and services
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