Personal preferences and treatment choice in an intervention trial of men newly diagnosed with localized prostate cancer.

Abstract

170 Background: Men diagnosed with localized prostate cancer (LPC) can choose from multiple treatment regimens and are faced with a decision in which medical factors and personal preferences are important. The Personal Patient Profile-Prostate (P3P) is a computerized decision aid for men with LPC that focuses on personal preferences. We determined the proportion of men with LPC who chose a concordant treatment approach by 6-months with self-reported, influential side effects by intervention or control group, and evaluated whether the intervention (versus control) group was more likely to choose a concordant treatment. Methods: English or Spanish-speaking men diagnosed with LPC (2007–2009) from four US cities were enrolled into a randomized trial and followed at 1- and 6-months via mailed or online questionnaire. Men were randomized to receive the P3P intervention or standard education plus links to reputable websites (control group). We classified concordance as men who were (a) concerned with urinary incontinence and/or erectile dysfunction and chose radiotherapy, (b) concerned with bowel dysfunction and chose prostatectomy, (c) concerned with all three side effects and chose watchful waiting, or (d) not concerned with any side effect and chose any treatment. We calculated the proportion of concordance by group. Using logistic regression, we calculated odds ratios (OR) and 95% confidence intervals (CI) for the association between the P3P intervention and concordance. Results: Of 448 men, most were <65 years, non-Hispanic white, and had multiple physician consultations prior to study enrollment. Only 43% of the sample chose a concordant treatment given concerns about potential side effects. There was no significant difference in concordance between the intervention (43%) and control (42%) group (OR=1.1; 95%CI=0.73, 1.7). Conclusions: The P3P intervention was not associated with concordance between potential side effects and treatment choice. Information and/or physician consultation immediately after diagnosis was likely to influence decisions despite concerns about side effects. The intervention may be more effective before the first treatment options consultation.