Decisional conflict among patients with prostate cancer considering germline testing

Decisional conflict has not been well characterized in patients with prostate cancer (PCa) considering germline testing. Understanding variations in decisional conflict may explain disparities in germline testing uptake. A prospective study of patients with PCa seen at a hybrid oncology/genetics “genetic testing station” (GTS) was conducted. After pre-test counseling from the referring oncologist and video education facilitated by a genetic counseling assistant, presence/absence of patient-reported decisional conflict was assessed using the SURE Test. Patient clinical and demographic data were collected from the electronic health record. Chi-squared tests and univariable logistic regressions were conducted to determine the association of decisional conflict with clinical and demographic factors. Of 853 eligible patients approached, 650 (76%) patients completed the decisional conflict instrument. Sixty (9%) patients experienced decisional conflict. No factors, including race, were associated with decisional conflict. Decisional conflict was uncommon and similar across subgroups. GTS may be a model to deliver high-volume, equitable pre-test genetic counseling and decision support. Further research is needed to understand sources of disparities in germline testing uptake.