MP04-09 DOES A CLEAR UNDERSTANDING OF LIFE EXPECTANCY INCREASE DECISIONAL CONFLICT AND ANXIETY FOR MEN WITH NEWLY DIAGNOSED PROSTATE CANCER?

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2016MP04-09 DOES A CLEAR UNDERSTANDING OF LIFE EXPECTANCY INCREASE DECISIONAL CONFLICT AND ANXIETY FOR MEN WITH NEWLY DIAGNOSED PROSTATE CANCER? Mazen Alsinnawi, April E. Slee, John S. Banerji, Kathryn L. Dahl, Sydney Akapame, John D Massman III, Erika M. Wolff, and John M. Corman Mazen AlsinnawiMazen Alsinnawi More articles by this author , April E. SleeApril E. Slee More articles by this author , John S. BanerjiJohn S. Banerji More articles by this author , Kathryn L. DahlKathryn L. Dahl More articles by this author , Sydney AkapameSydney Akapame More articles by this author , John D Massman IIIJohn D Massman III More articles by this author , Erika M. WolffErika M. Wolff More articles by this author , and John M. CormanJohn M. Corman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (CaP) decision making is complicated by multiple treatment choices with implications for survival and quality of life. Although knowledge of the effect of co-morbidities on life expectancy helps clinicians to determine the range of treatment options available for their patients, patients are not usually, explicitly given this information. We utilized the Charlson Comorbidity Index (CCI) to predict life expectancy in men with newly diagnosed CaP. The objective of this study is to determine whether providing patients with their CCI score increases treatment decisional conflict and anxiety about death. METHODS Patients with newly diagnosed CaP were randomized to receive standard multidisciplinary care versus the same counseling with the addition of the patient's prospective understanding of his CCI score. Patients subsequently completed the Decisional Conflict Scale (DCS) and the Death Anxiety Scale (DAS). The primary objective was to determine whether telling patients their life expectancy complicated their treatment decisions and increased their anxiety levels. Five percent non inferiority margin was used for both instruments. Because the primary hypothesis was safety, patients were analyzed according to the intervention they received. RESULTS A total of 228 patients returned surveys, 123 received standard counselling and 105 were prospectively informed of their CCI. Mean age was 65 years. 17% had high risk CaP and the median 10-year survival probability was 80.9%. There was no statistical significant difference in planned treatment choice (active surveillance vs active treatment).18.7 % of the standard counselling group reported significant decisional conflict (> 37.5 points) compared to 10.5 % in the CCI group (p=0.08). Those who received CCI counseling had a mean decisional conflict score of 19.4, compared to 22.1 for the standard group. The difference between these was on average -2.7 points (95% CI -6.8, 1.3) which excludes the 5 % non-inferiority margin (range 0-100). The difference for DAS was -0.24 (95% CI, -1.08, 0.60) which excludes the 5 % margin (range 0-15). CONCLUSIONS Knowledge of CCI does not increase decisional conflict or anxiety about death, and may reduce the incidence of significant conflict. As we embrace the concept of shared decision making in urology, it is expected that the full disclosure of life expectancy will be standard of care. This study suggest that this disclosure can be made without contributing to patient stress and anxiety. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e31 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mazen Alsinnawi More articles by this author April E. Slee More articles by this author John S. Banerji More articles by this author Kathryn L. Dahl More articles by this author Sydney Akapame More articles by this author John D Massman III More articles by this author Erika M. Wolff More articles by this author John M. Corman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...