Decision aids maybe be underutilized in treating prostate cancer

1. Radiation oncologists and urologists surveyed in this study did not commonly use decision aids when discussing treatment options with patients.

2. The most commonly cited barriers to use of decisions aids were the perception that their ability to estimate the risk of recurrence was superior to the decision aid, as well as that patients could not process information from the decision aid.

Evidence Rating Level: 4 (Below Average) 

Study Rundown: There are a variety of modalities used to treat clinically localized prostate cancer, including surgery, surveillance, radiotherapy, or a combination thereof. The decision hinges on clinical practice guidelines based on previously developed risk stratifications, but is also heavily dependent on the patient and what long-term risks and side effects of treatment they are willing to shoulder. As a means of better involving patients in the shared decision making between them and their care providers, various written ‘decision aids’ have been developed which clearly explain and compare options. Decision aids are written guides that can help patients and physicians converse about treatment options for prostate cancer. Previous studies have suggested that decision aids are a benefit to patients.

This study was designed to assess the use of clinical decision aids and clinician attitudes towards decision aids. It was found that about one third of clinicians used decision aids in practice, and it was commonly believed that their ability to estimate recurrence was superior to that of decision aids. Limitations of the study include the survey methodology which relies on respondent self-reporting of behavior. Despite multiple attempts to contact non-responders, ultimately there was only a 45% response rate, which limits interpretation of the data.

Click to read the study, published today in JAMA Internal Medicine

Click to read an invited commentary in JAMA Internal Medicine

Relevant Reading: Decision aids to help people who are facing health treatment or screening decisions

In-Depth [survey]: This survey study involved radiation oncologists and urologists who were randomly selected from the American Medical Association Physician Masterfile. The finalized form of the survey assessed use of decision aids (DAs) in clinical practice, familiarity and usefulness of DAs, perceptions about barriers towards DAs, and trust in other organizations promoting DAs for prostate cancer. The final survey was sent to 1422 physicians, and a $10 incentive was provided for completing the survey.

Ultimately, 641 physicians responded for an overall response rate of 45.1%, which was not significantly different between radiation oncologists and urologists. Only 35.5% of those surveyed used a decision aid in their clinical practice. The most commonly cited barriers were the perception that the respondent’s ability to estimate the risk of recurrence was superior to that of the decision aid, as well as that the average patient could not process information from the decision aid. 16.5% of respondents felt that decision aids were very useful, and only 9.2% were “very confident” that using decision aids improves treatment decisions.

Image: PD

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