Implementation of prostate cancer treatment decision aid in Michigan: a qualitative study

Abstract

Background The American Urological Association White Paper on Implementation of Shared Decision Making (SDM) into Urological Practice suggested SDM represents the state of the art in counseling for patients who are faced with difficult or uncertain medical decisions. The Michigan Urological Surgery Improvement Collaborative (MUSIC) implemented a decision aid, Personal Patient Profile-Prostate (P3P), in 2018 to help newly diagnosed prostate cancer patients make shared decisions with their clinicians. We conducted a qualitative study to assess statewide implementation of P3P throughout MUSIC. Methods We recruited urologists and staff from 17 MUSIC practices (8 implementation and 9 comparator practices) to understand how practices engaged patients on treatment discussions and to assess facilitators and barriers to implementing P3P. Interview guides were developed based on the Tailored Interventions for Chronic Disease (TICD) Framework. Interviews were transcribed for analysis and coded independently by two investigators in NVivo, PRO 12. Additionally, quantitative program data were integrated into thematic analyses. Results We interviewed 15 urologists and 11 staff from 16 practices. Thematic analysis of interview transcripts indicated three key themes including the following: (i) P3P is compatible as a SDM tool as over 80% of implementation urologists asked patients to complete the P3P questionnaire routinely and used P3P reports during treatment discussions; (ii) patient receptivity was demonstrated by 370 (50%) of newly diagnosed patients (n = 737) from 8 practices enrolled in P3P with 78% completion rate, which accounts for 39% of all newly diagnosed patients in these practices; and (iii) urologists’ attitudes towards SDM varied. Over a third of urologists stated they did not rely on a decision aid. Comparator practices indicated habit, inertia, or concerns about clinic flow as reasons for not adopting P3P and some were unconvinced a decision aid is needed in their practice. Conclusion Urologists and staff affiliated with MUSIC implementation sites indicated that P3P focuses the treatment discussion on items that are important to patients. Experiences of implementation practices indicate that once initiated, there were no negative effects on clinic flow and urologists indicated P3P saves time during patient counseling, as patients were better prepared for focused discussions. Lack of awareness, personal habits, and inertia are reasons for not implementing P3P among the comparator practices.

Factors Associated with Decision Aid Use in Localized Prostate Cancer

“…The differences in clinicians' perspectives on use of decision aids in urology may explain the variation in urologists' effect on their use. 7,15,22 On multivariable analyses of data from the American Urological Association's Annual Census, we found that urologists' level of training, practice environment, and clinical volume influenced self-reported shared decision making and decision aid use. 7 In a similar study of Dutch practitioners caring for patients with metastatic castrate resistant PCa, de Angst et al found that less than half of urologists stated that a decision aid is appropriate for treatment decisions when patients have a choice between 2 or more treatment options.…”

“…One reason for the divergence in physician engagement with decision aids may be that despite strong evidence to support that decision aids improve several patient centered metrics (decisional regret, knowledge), these metrics may not align with outcomes that clinicians traditionally value (health outcomes). 7,15,25 Efforts to evaluate the impact of shared decision making and decision aid use on health outcomes beyond decisional impact may increase clinician engagement.…”

“…In 2018, MUSIC implemented a novel pilot initiative through the Movember Foundation and True North (TrueNTH USA) to use the Personal Patient Profile-Prostate (P3P), a web-based, PCa decision aid. 11–15 MUSIC maintains prospectively collected data regarding P3P use at the patient, urologist and practice level. The aim of this study was to assess the factors that were associated with patients’ registration to use P3P.…”

Applying the Tailored Implementation in Chronic Diseases framework to inform implementation of the Preferences Elicited and Respected for Seriously Ill Veterans through enhanced decision-making program in the United States Veterans Health Administration

“…Step : Primary analyst coding Within 24-72 hours after the interview, the primary analyst codes the interview notes to the appropriate TICD determinants in the Microsoft Word TICD template (Appendix 2) (17,25,30). The primary analyst uses comments within Microsoft Word to flag sections to discuss during the consensus meeting with the secondary analyst.…”

Correction: Implementation of prostate cancer treatment decision aid in Michigan: a qualitative study

“…Following the publication of the original article [ 1 ] the authors requested to update the “Competing interests” section as follows:…”