Nurse-Delivered Decision Tool Supports Patient Decision Making in Prostate Cancer

July 25, 2016
Ellie Leick

To help patients decide whether active surveillance or a more aggressive approach is best to treat their localized, low-risk prostate cancer, researchers at Thomas Jefferson University created an online decision-support tool that relies on a trained nurse educator to help patients better understand their treatment options.

Ronald E. Myers, PhD

To help patients decide whether active surveillance or a more aggressive approach is best to treat their localized, low-risk prostate cancer, researchers at Thomas Jefferson University created an online decision-support tool that relies on a trained nurse educator to help patients better understand their treatment options.

Findings of a pilot study exploring the utility of the tool were published in the Journal of Cancer Education and are based on feedback from 30 patients with localized, low-risk prostate cancer who participated in the study. The results suggest that more men chose active surveillance after taking part in the Decision Counseling Program, and they were less likely to feel conflicted about the decision than they were beforehand.

Clinicians cannot foresee who is at risk for developing aggressive disease and thus may benefit from active treatment. Due to the uncertainty, most men choose active treatment over surveillance.

Previous decision aids have relied upon educational handouts, booklets, or videos used to deliver information to patients. While these aids helped increase the number of men choosing active surveillance, a prior review of the research literature yielded mixed results on their usefulness. With the Decision Counseling Program, 83% of participants (25 of 30) chose active surveillance rather than active treatment, a rate much higher than what is typical.

After using the program, patients had a higher level of knowledge about their treatment options, reported feeling less conflicted about the treatment decision, and had more favorable perceptions of active surveillance than they did at the outset of the study.

“The Decision Counseling Program is used by a trained nurse educator to help patients understand their options, figure out what things would make them favor one option over the other, and clarify the option they prefer,” explained study author Ronald E. Myers, PhD, in a statement. Myers is a professor of Medical Oncology and a researcher at the Sidney Kimmel Cancer Center at Jefferson.

Not only does this new system engage a nurse educator to provide information about options, but the nurse also identifies and weighs the importance of issues that matter to the patients, such as worries about treatment side effects or concerns about developing aggressive cancer. The Decision Counseling Program also produces a 1-page summary to guide patient—provider discussions.

“The power in the approach is that it gives the patient time to consider the options, put personal thoughts and concerns on the table, and have a voice in the decision making process,” noted corresponding author Amy Leader DrPH, MPH, assistant professor of Medical Oncology and researcher at the Sidney Kimmel Cancer Center at Jefferson.

The researchers see potential to apply this approach in other treatment situations where options are available, decisions are difficult, and the stakes are high. Myers said that work is under way on an adaptation aimed at helping patients decide whether a clinical trial is right for them.

Myers RE, Leader AE, Censits JH, et al. Decision support and shared decision making about active surveillance versus active treatment among men diagnosed with low-risk prostate cancer: a pilot study [published online ahead of print July 15, 2016]. J Cancer Educ.