Reducing decisional conflict in men making treatment decisions on newly diagnosed localized prostate cancer.

Abstract

106 Background: Men with newly diagnosed localized prostate cancer (LPC) face a complex, preference-sensitive treatment decision. Low “decisional conflict” (DC), defined as uncertainty over treatment choice, is a key component of decision quality. Lower scores on the Decisional Conflict Scale (DCS) are associated with lower likelihood of delaying a decision and assessing blame to a physician for bad outcomes. We hypothesized that using a novel software application to measure and report patients’ preferences for LPC treatment outcomes as part of a pre-consultation intervention would improve decisional quality in men with LPC by reducing DC. Methods: Men with newly diagnosed LPC completed the online WiserCare (WiserCare, Inc) prostate cancer module prior to their initial consultation at the University of North Carolina, Chapel Hill Multi-disciplinary Urologic Oncology Clinic. WiserCare is a software application that provides education, preference assessment, and personalized decision analysis for patients. Preferences are measured using conjoint analysis. WiserCare then generates an individualized report ranking treatment options based on their “fit”(expected value) based on clinical prognostic factors and personal preferences. This report is used with their physician during counseling. We measured DCS scores before and after completion of the WiserCare module. Paired 2-tailed T-tests were to evaluate the changes in DCS scores. Results: 48 men completed the WiserCare module and DCS prior to their initial consultation for newly diagnosed LPC. Overall DCS score decreased by 38% (p<0.00001) after completion of the WiserCare module. Analysis of DCS subscales revealed improvements in all five, including feeling informed by 56% (p<0.00001), value clarity by 49% (p=0.001), feeling effective in decision making by 36% (p=0.0001), feeling supported by 31% (p=0.0037), and reduced uncertainty by 24% (p=0.0023). Conclusions: A pre-consultation web-based module integrating evidence-based information, individualized clinical data and personal preference data is a feasible and effective strategy to reduce decisional conflict in men making treatment choices for localized prostate cancer.