Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer

Joseph D. Shirk (), Catherine M. Crespi, Josemanuel D. Saucedo, Sylvia Lambrechts, Ely Dahan, Robert Kaplan and Christopher Saigal
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Joseph D. Shirk: David Geffen School of Medicine at UCLA
Catherine M. Crespi: UCLA Fielding School of Public Health
Josemanuel D. Saucedo: David Geffen School of Medicine at UCLA
Sylvia Lambrechts: David Geffen School of Medicine at UCLA
Ely Dahan: UCLA Anderson School of Management
Robert Kaplan: UCLA Fielding School of Public Health
Christopher Saigal: David Geffen School of Medicine at UCLA

The Patient: Patient-Centered Outcomes Research, 2017, vol. 10, issue 6, No 13, 785-798

Abstract: Abstract Background Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement. Objectives We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting. Methods Men with incident localized prostate cancer (n = 122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation. Results Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p = 0.023) and the Perceived Effective Decision Making subscale (p = 0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups. Conclusions Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.

Date: 2017
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DOI: 10.1007/s40271-017-0255-7

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