Factors Associated with Decision Aid Use in Localized Prostate Cancer

Abstract

Introduction: Decision aids have been found to improve patients' knowledge of treatments and decrease decisional regrets. Despite these benefits, there is not widespread use of decision aids for newly diagnosed prostate cancer (PCa). This analysis investigates factors that impact men's choice to use a decision aid for newly diagnosed PCa.Methods: This is a retrospective analysis of a PCa registry from the Michigan Urological Surgery Improvement Collaborative. We included data from men with newly diagnosed, clinically localized PCa seen from 2018e2021 at practices offering a PCa decision aid (Personal Patient Profile-Prostate [P3P]). The primary outcome was men's registration to use P3P. We fit a multilevel logistic regression model with patient-level factors and included urologist specific random intercepts. We estimated the intraclass correlation and predicted the probability of P3P registration among urologists.Results: A total of 2,629 men were seen at practices that participated in P3P and 1,174 (45%) registered to use P3P. In all, 41% of the total variance of P3P registration was attributed to clustering of men under a specific urologist's care. In contrast, only 1.5% of the variance of P3P registration was explained by patient factors. Our model did not include data on socioeconomic, literacy or psychosocial factors, which limits the interpretation of the results.Conclusions: These results suggest that urologists' effect far outweighs patient factors in a man's decision to enroll in P3P. Strategies that encourage providers to increase decision aid adoption in their practices are warranted.

Editorial Comment

“…The "urologist effect" has been described to account for variations in the treatment of prostate cancer that do not align with clinical characteristics nor patient preferences. 3 Because most urologists are primarily surgical and do not undergo specialized training in metabolic stone disease, they may be biased by a lack of experience in medical prevention of nephrolithiasis or the perception of a lack of efficacy. Nevertheless, urologists have the opportunity and duty to treat and prevent acute and chronic consequences of nephrolithiasis.…”

Delivering patient‐centered care through shared decision making in overactive bladder

“…4,24 Recent data point to urologists as key facilitators of SDM and decision aid use and clinician engagement may be a way to overcome this barrier. 50 We present SDM for OAB within the context of the tier-based treatment framework recommended by the American Urological Association guidelines and focus our review on therapies included in the guidelines. Prior researchers have noted that a sequential treatment approach may not foster a patient-centered approach.…”

“…Challenges to implementation and use of SDM have been well documented within urology 4,24 . Recent data point to urologists as key facilitators of SDM and decision aid use and clinician engagement may be a way to overcome this barrier 50 . We present SDM for OAB within the context of the tier‐based treatment framework recommended by the American Urological Association guidelines and focus our review on therapies included in the guidelines.…”