Patient Decision Aids for Prostate Cancer Treatment: A Systematic Review of the Literature§

Authors

  • Grace A. Lin MD, MAS,

    Corresponding author
    1. Assistant Professor, Division of General Internal Medicine and Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA
    • Division of General Internal Medicine, University of California at San Francisco, 400 Parnassus Avenue, 4th Floor, Box 0320, San Francisco, CA 94143-0320
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  • David S. Aaronson MD,

    1. Chief Resident, Department of Urology, University of California at San Francisco, San Francisco, CA
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  • Sara J. Knight PhD,

    1. Associate Professor, Health Services Research and Development, Veterans Affairs Medical Center, San Francisco, CA
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  • Peter R. Carroll MD, MPH,

    1. Professor, Department of Urology, University of California at San Francisco, San Francisco, CA
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  • R. Adams Dudley MD, MBA

    1. Professor of Medicine and Health Policy, Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA
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  • To earn free CME credit or nursing contact hours for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org.

  • DISCLOSURES: Drs. Lin, Knight, and Dudley have all received research funding from the Foundation for Informed Medical Decision Making. A portion of Dr. Lin's work was supported by a grant from the University of California at San Francisco (UCSF) Center for Aging and Diverse Communities. A portion of Dr. Dudley's work was supported by an Investigator Award in Health Policy from the Robert Wood Johnson Foundation. The UCSF Center for Aging and Diverse Communities, the Foundation for Informed Medical Decision Making, and the Robert Wood Johnson Foundation had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or the preparation, review, or approval of the article. No other potential conflict of interest relevant to this article was reported.

  • §

    Available online at http://cajournal.org and http://cacancerjournal.org

Abstract

Treatment decision-making can be difficult and complex for patients with low-risk prostate cancer. To the authors' knowledge, there is no consensus regarding an optimal treatment strategy and the choice of therapy involves tradeoffs between differing harms and benefits that are sensitive to patient values. In such situations, patients are often asked to participate actively in the decision-making process, and high-quality decisions require a well-informed patient whose values and preferences have been taken into consideration. Prior studies have indicated that patients have poor knowledge and unrealistic expectations regarding treatment, and physician judgments concerning patient preferences are often inaccurate. Decision aids (DAs) have been developed to help inform patients with low-risk prostate cancer about treatment options and assist in the decision-making process; however, little is currently known regarding the effects of such programs in this population. Thirteen studies of DAs for patients with prostate cancer were reviewed and it was found that the use of DAs can improve knowledge, encourage more active patient involvement in decision-making, and decrease levels of anxiety and distress. The effect of DAs on treatment choice was less clear, although fewer patients chose surgery compared with historical controls, particularly in Europe. Further studies are needed to determine how best to implement DAs into practice, and whether they improve the consistency between patient preferences and treatment choice. CA Cancer J Clin 2009. © 2009 American Cancer Society, Inc.

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