期刊
CANCER
卷 127, 期 2, 页码 203-208出版社
WILEY
DOI: 10.1002/cncr.33241
关键词
active surveillance; decision making; decision support techniques; prostate cancer; risk
类别
资金
- National Institutes of Health/National Institute of Nursing Research [R01NR009692]
- American Cancer Society [MRSG-18-01-CPHPS]
- American Cancer Society postdoctoral fellowship
- Society for Medical Decision Making/Gordon and Betty Moore Foundation
In a trial assessing a decision support tool for prostate cancer treatment, it was found that Black race and restricted treatment options were associated with less use of active surveillance for low-risk patients. Despite reducing decisional conflict, the use of the P3P tool did not lead to more appropriate treatment choices.
Background Decision support tools improve decisional conflict and elicit patient preferences related to prostate cancer treatment. It was hypothesized that men using the Personal Patient Profile-Prostate (P3P) would be more likely to pursue guideline-concordant treatment. Methods Men from a trial assessing the P3P decision support intervention were identified. The primary exposure was allocation to P3P (vs usual care), and the outcome was appropriate treatment per guidelines (eg, low risk = active surveillance). It was assessed whether providers recommended against any treatment options (ie, restricted). A multivariable model was fit for men with low-risk cancer that estimated the odds of the outcome of interest. Results This study identified 295 men in the cohort: 113 (38%) had low-risk disease, 119 (40%) had favorable intermediate-risk disease, and 63 (21%) had unfavorable intermediate-risk disease. Among low-risk patients, more men pursued active surveillance after using P3P whether they were given unrestricted (62% vs 54% with usual care; P = .54) or restricted options (71% vs 59% with usual care; P = .34). After adjustments, only Black race (odds ratio [OR], 0.31; 95% CI, 0.11-0.89) and restricted options (OR, 0.23; 95% CI, 0.08-0.65) had an inverse association with the receipt of surveillance for patients with low-risk prostate cancer. An impact associated with P3P versus usual care (OR, 0.89; 95% CI, 0.36-2.20) was not observed. Conclusions Among men in a trial assessing a decision support tool, Black race and restricted treatment options were associated with less use of active surveillance for low-risk prostate cancer. Although the P3P instrument ameliorates decisional conflict, its use was not associated with more appropriate alignment of treatment with disease risk.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据