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Decision support for men with prostate cancer: Concordance between treatment choice and tumor risk
Author(s) -
Filson Christopher P.,
Hong Fangxin,
Xiong Niya,
Pozzar Rachel,
Halpenny Barbara,
Berry Donna L.
Publication year - 2021
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.33241
Subject(s) - medicine , prostate cancer , concordance , odds ratio , guideline , disease , cohort , cancer , odds , gynecology , logistic regression , pathology
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.