1001 Decisional Conflict Varies by Institution for Men Making Treatment Decisions for Localized Prostate Cancer

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You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111001 DECISIONAL CONFLICT VARIES BY INSTITUTION FOR MEN MAKING TREATMENT DECISIONS FOR LOCALIZED PROSTATE CANCER Donna Berry, Fangxin Hong, Barbara Halpenny, Seth Wolpin, William Lober, Kenneth Russell, William Ellis, B. Joyce Davison, Andrea Barsevick, Claire Yang, Daniel Lin, and Gerald Bennett Donna BerryDonna Berry Boston, MA More articles by this author , Fangxin HongFangxin Hong Boston, MA More articles by this author , Barbara HalpennyBarbara Halpenny Boston, MA More articles by this author , Seth WolpinSeth Wolpin Seattle, WA More articles by this author , William LoberWilliam Lober Seattle, WA More articles by this author , Kenneth RussellKenneth Russell Seattle, WA More articles by this author , William EllisWilliam Ellis Seattle, WA More articles by this author , B. Joyce DavisonB. Joyce Davison Saskatoon, Canada More articles by this author , Andrea BarsevickAndrea Barsevick Philadephia, PA More articles by this author , Claire YangClaire Yang Seattle, WA More articles by this author , Daniel LinDaniel Lin Seattle, WA More articles by this author , and Gerald BennettGerald Bennett Augusta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1034AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Diagnosed with localized prostate cancer (LPC), men often struggle to make “the best” treatment decision. The Personal Patient Profile-Prostate (P3P), a customized Internet-based decision support system for men with LPC, has been shown to significantly reduce decisional conflict in a multi-site randomized trial. In this diverse sample of men with LPC, we explored differences in the decisional conflict (DC) outcome between clinical study sites. METHODS Men with newly diagnosed LPC in Seattle, Philadelphia, San Antonio and Augusta (3 Veterans Administration urology sites, 1 private radiation oncology site, 1 cancer center radiation oncology site, and 1 cancer center multidisciplinary clinic site) were invited to enter the P3P program prior to their consultation visit with a cancer specialist. All participants answered questionnaires at baseline, 1 and 6 months, including the DC Scale (+3 subscales). Men randomized to the intervention group received the P3P text and video coaching, customized to race and age. Generalized Estimating Equation (GEE) was used to model the DC outcomes at 1 and 6 months, adjusting for baseline DC scores and potential predictive demographic/clinical factors. Separate models were used for each subscale and the total score. Chi-square and one-way ANOVA were used for comparing baseline demographic factors among study sites. RESULTS A total of 494 eligible men were enrolled and randomized with 15% minority participation. Differences between study sites were found for decisional conflict in all three subscales (decisional uncertainty, p=0.0082; factors contributing to uncertainty, p= 0.0015, effective decision-making, p=0.0026) and total scores (p=0.0074). Though baseline demographics (education, income, race, weeks since diagnosis, home Internet access) were significantly different by site (p<0.0001), the difference in DC among sites remained after adjusting for these demographics and baseline DC scores in the GEE model. Participants at the Augusta Veterans Administration urology clinic reported highest decisional conflict, while patients at Seattle Prostate Institute reported lowest decisional conflict. CONCLUSIONS Men with LPC receiving care at institutional settings of various types are likely to have different levels of decision conflict and this is not fully explained by participant demographics. Differences between sites on unknown variables may explain the finding. Future analyses and further research are indicated to uncover the origin of this difference. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e403 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Donna Berry Boston, MA More articles by this author Fangxin Hong Boston, MA More articles by this author Barbara Halpenny Boston, MA More articles by this author Seth Wolpin Seattle, WA More articles by this author William Lober Seattle, WA More articles by this author Kenneth Russell Seattle, WA More articles by this author William Ellis Seattle, WA More articles by this author B. Joyce Davison Saskatoon, Canada More articles by this author Andrea Barsevick Philadephia, PA More articles by this author Claire Yang Seattle, WA More articles by this author Daniel Lin Seattle, WA More articles by this author Gerald Bennett Augusta, GA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...