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Sweileh WM. Analysis and mapping the research landscape on patient-centred care in the context of chronic disease management. J Eval Clin Pract 2024; 30:638-650. [PMID: 38567707 DOI: 10.1111/jep.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 02/07/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024]
Abstract
RATIONALE Patient-centred care has emerged as a transformative approach in managing chronic diseases, aiming to actively involve patients in their healthcare decisions. AIMS AND OBJECTIVES This study was conducted to analyse and map the research landscape on patient-centred care in the context of chronic disease management. METHODS This study used Scopus to retrieve the relevant articles. The analysis focused on the growth pattern, highly cited articles, randomised clinical trials, patients and providers perspectives, facilitators and barriers, frequent author keywords, emerging topics, and prolific countries and journals in the field. RESULTS In total, 926 research articles met the inclusion criteria. There was a notable increase in the number of publications over time. Cancer had the highest number of articles (n = 379, 40.9%), followed by diabetes mellitus, and mental health and psychiatric conditions. Studies on patient-centred care in diabetic patients received the highest number of citations. The results identified 52 randomised controlled trials that covered four major themes: patient-centred care for diabetes management, shared decision-making in mental health and primary care, shared decision-making in cancer care, and economic evaluation and cost-effectiveness. The study identified 51 studies that examined the impact of tools such as computer-based systems, decision aids, smartphone apps, and online tools to improve patient-centred outcomes. A map of author keywords showed that renal dialysis, HIV, and atrial fibrillation were the most recent topics in the field. Researchers from the United States contributed to more than half of the retrieved publications. The top active journals included "Patient Education and Counselling" and "Health Expectations". CONCLUSION This study provides valuable insights into the research landscape of patient-centred care within the context of chronic diseases. The current study provided a comprehensive overview of the research landscape on patient-centred care, which can empower patients by raising their awareness about clinical experiences and outcomes.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology and Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Gartrell BA, Phalguni A, Bajko P, Mundle SD, McCarthy SA, Brookman-May SD, De Solda F, Jain R, Yu Ko W, Ploussard G, Hadaschik B. Influential Factors Impacting Treatment Decision-making and Decision Regret in Patients with Localized or Locally Advanced Prostate Cancer: A Systematic Literature Review. Eur Urol Oncol 2024:S2588-9311(24)00106-8. [PMID: 38744587 DOI: 10.1016/j.euo.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/06/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
CONTEXT Treatment decision-making (TDM) for patients with localized (LPC) or locally advanced (LAPC) prostate cancer is complex, and post-treatment decision regret (DR) is common. The factors driving TDM or predicting DR remain understudied. OBJECTIVE Two systematic literature reviews were conducted to explore the factors associated with TDM and DR. EVIDENCE ACQUISITION Three online databases, select congress proceedings, and gray literature were searched (September 2022). Publications on TDM and DR in LPC/LAPC were prioritized based on the following: 2012 onward, ≥100 patients, journal article, and quantitative data. The Preferred Reporting Items Reviews and Meta-analyses guidelines were followed. Influential factors were those with p < 0.05; for TDM, factors described as "a decision driver", "associated", "influential", or "significant" were also included. The key factors were determined by number of studies, consistency of evidence, and study quality. EVIDENCE SYNTHESIS Seventy-five publications (68 studies) reported TDM. Patient participation in TDM was reported in 34 publications; overall, patients preferred an active/shared role. Of 39 influential TDM factors, age, ethnicity, external factors (physician recommendation most common), and treatment characteristics/toxicity were key. Forty-nine publications reported DR. The proportion of patients experiencing DR varied by treatment type: 7-43% (active surveillance), 12-57% (radical prostatectomy), 1-49% (radiotherapy), 28-49% (androgen-deprivation therapy), and 21-47% (combination therapy). Of 42 significant DR factors, treatment toxicity (sexual/urinary/bowel dysfunction), patient role in TDM, and treatment type were key. CONCLUSIONS The key factors impacting TDM were physician recommendation, age, ethnicity, and treatment characteristics. Treatment toxicity and TDM approach were the key factors influencing DR. To help patients navigate factors influencing TDM and to limit DR, a shared, consensual TDM approach between patients, caregivers, and physicians is needed. PATIENT SUMMARY We looked at factors influencing treatment decision-making (TDM) and decision regret (DR) in patients with localized or locally advanced prostate cancer. The key factors influencing TDM were doctor's recommendation, patient age/ethnicity, and treatment side effects. A shared, consensual TDM approach between patients and doctors was found to limit DR.
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Affiliation(s)
- Benjamin A Gartrell
- Departments of Oncology and Urology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA.
| | - Angaja Phalguni
- Evidence Synthesis, Genesis Research Group, Newcastle upon Tyne, UK
| | - Paulina Bajko
- Evidence Synthesis, Genesis Research Group, Newcastle upon Tyne, UK
| | - Suneel D Mundle
- Global Medical Affairs, Janssen Research & Development, Raritan, NJ, USA
| | - Sharon A McCarthy
- Clinical Research Oncology, Janssen Research & Development, Raritan, NJ, USA
| | - Sabine D Brookman-May
- Clinical Research Oncology, Janssen Research & Development, Spring House, PA, USA; Ludwig-Maximilians-University, München, Germany
| | - Francesco De Solda
- Global Commercial Strategy Organization, Janssen Global Services, Raritan, NJ, USA
| | - Ruhee Jain
- Global Commercial Strategy Organization, Janssen Global Services, Raritan, NJ, USA
| | - Wellam Yu Ko
- University of British Columbia Men's Health Research Program, Vancouver, BC, Canada
| | | | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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Knight JM, Ward MK, Fernandez S, Genberg BL, Beach MC, Ladner RA, Trepka MJ. Perceptions and Current Practices in Patient-Centered Care: A Qualitative Study of Ryan White HIV Providers in South Florida. J Int Assoc Provid AIDS Care 2024; 23:23259582241244684. [PMID: 38651291 PMCID: PMC11036924 DOI: 10.1177/23259582241244684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 02/12/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024] Open
Abstract
Background: Patient-centered care (PCC) improves HIV adherence and retention, though lack of consensus on its conceptualization and understanding how it is interpreted has hindered implementation. Methods: We recruited 20 HIV providers at Ryan White Programs in FL for in-depth interviews. Thematic analysis identified core consistencies pertaining to: 1) provider perceptions, 2) current practices promoting PCC. Results: Provider perceptions of PCC emerged under four domains: 1) holistic, 2) individualized care, 3) respect for comfort and security, and 4) patient engagement and partnership. PCC practices occurred at multiple levels: 1) individual psychosocial and logistical support, 2) interpersonal support within patient-provider relationships through respectful communication and active engagement, and 3) institutional practices including feedback mechanisms, service integration, patient convenience, and diverse staffing. Conclusions: Our findings highlight the central tenets of PCC as respectful, holistic, individualized, and engaging care. We offer an HIV-adapted framework of PCC as a multilevel construct to guide future intervention.
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Affiliation(s)
- Jennifer M. Knight
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Sofia Fernandez
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Becky L. Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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Ciccone G, De Luca S, Oderda M, Munoz F, Krengli M, Allis S, Baima CG, Barale M, Bartoncini S, Beldì D, Bellei L, Bellissimo AR, Bernardi D, Biamino G, Billia M, Borsa R, Cante D, Castelli E, Cattaneo G, Centrella D, Collura D, Coppola P, Dalmasso E, Di Stasio A, Fasolis G, Fiorio M, Garibaldi E, Girelli G, Griffa D, Guercio S, Migliari R, Molinaro L, Montefiore F, Montefusco G, Moroni M, Muto G, Ponti di Sant’Angelo F, Ruggiero L, Ruo Redda MG, Serao A, Squeo MS, Stancati S, Surleti D, Varvello F, Volpe A, Zaramella S, Zarrelli G, Zitella A, Bollito E, Gontero P, Porpiglia F, Galassi C, Bertetto O. Patient and Context Factors in the Adoption of Active Surveillance for Low-Risk Prostate Cancer. JAMA Netw Open 2023; 6:e2338039. [PMID: 37847502 PMCID: PMC10582795 DOI: 10.1001/jamanetworkopen.2023.38039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/17/2023] [Indexed: 10/18/2023] Open
Abstract
Importance Although active surveillance for patients with low-risk prostate cancer (LRPC) has been recommended for years, its adoption at the population level is often limited. Objective To make active surveillance available for patients with LRPC using a research framework and to compare patient characteristics and clinical outcomes between those who receive active surveillance vs radical treatments at diagnosis. Design, Setting, and Participants This population-based, prospective cohort study was designed by a large multidisciplinary group of specialists and patients' representatives. The study was conducted within all 18 urology centers and 7 radiation oncology centers in the Piemonte and Valle d'Aosta Regional Oncology Network in Northwest Italy (approximate population, 4.5 million). Participants included patients with a new diagnosis of LRPC from June 2015 to December 2021. Data were analyzed from January to May 2023. Exposure At diagnosis, all patients were informed of the available treatment options by the urologist and received an information leaflet describing the benefits and risks of active surveillance compared with active treatments, either radical prostatectomy (RP) or radiation treatment (RT). Patients choosing active surveillance were actively monitored with regular prostate-specific antigen testing, clinical examinations, and a rebiopsy at 12 months. Main Outcomes and Measures Outcomes of interest were proportion of patients choosing active surveillance or radical treatments, overall survival, and, for patients in active surveillance, treatment-free survival. Comparisons were analyzed with multivariable logistic or Cox models, considering centers as clusters. Results A total of 852 male patients (median [IQR] age, 70 [64-74] years) were included, and 706 patients (82.9%) chose active surveillance, with an increasing trend over time; 109 patients (12.8%) chose RP, and 37 patients (4.3%) chose RT. Median (IQR) follow-up was 57 (41-76) months. Worse prostate cancer prognostic factors were negatively associated with choosing active surveillance (eg, stage T2a vs T1c: odds ratio [OR], 0.51; 95% CI, 0.28-0.93), while patients who were older (eg, age ≥75 vs <65 years: OR, 4.27; 95% CI, 1.98-9.22), had higher comorbidity (Charlson Comorbidity Index ≥2 vs 0: OR, 1.98; 95% CI, 1.02-3.85), underwent an independent revision of the first prostate biopsy (OR, 2.35; 95% CI, 1.26-4.38) or underwent a multidisciplinary assessment (OR, 2.65; 95% CI, 1.38-5.11) were more likely to choose active surveillance vs active treatment. After adjustment, center at which a patient was treated continued to be an important factor in the choice of treatment (intraclass correlation coefficient, 18.6%). No differences were detected in overall survival between active treatment and active surveillance. Treatment-free survival in the active surveillance cohort was 59.0% (95% CI, 54.8%-62.9%) at 24 months, 54.5% (95% CI, 50.2%-58.6%) at 36 months, and 47.0% (95% CI, 42.2%-51.7%) at 48 months. Conclusions and Relevance In this population-based cohort study of patients with LRPC, a research framework at system level as well as favorable prognostic factors, a multidisciplinary approach, and an independent review of the first prostate biopsy at patient-level were positively associated with high uptake of active surveillance, a practice largely underused before this study.
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Affiliation(s)
- Giovannino Ciccone
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Stefano De Luca
- Urologia, AOU San Luigi Gonzaga e Università di Torino, Orbassano, Italy
| | - Marco Oderda
- Urologia, AOU Città della Salute e della Scienza e Università di Torino, Torino, Italy
| | | | - Marco Krengli
- Radioterapia, AOU Maggiore della Carità e Università del Piemonte Orientale, Novara, Italy
| | - Simona Allis
- Radioterapia, AOU San Luigi Gonzaga, Orbassano, Italy
| | | | | | - Sara Bartoncini
- Radioterapia, AOU Città della Salute e della Scienza e Università di Torino, Torino, Italy
| | - Debora Beldì
- Radioterapia, AOU Maggiore della Carità e Università del Piemonte Orientale, Novara, Italy
| | - Luca Bellei
- Urologia, Ospedali Riuniti ASL TO4, Ivrea, Italy
| | - Andrea Rocco Bellissimo
- Rete Oncologica del Piemonte e Valle d’Aosta, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | | | | | - Michele Billia
- Urologia, AOU Maggiore della Carità e Università del Piemonte Orientale, Novara, Italy
| | | | | | | | - Giovanni Cattaneo
- Urologia, AOU San Luigi Gonzaga e Università di Torino, Orbassano, Italy
| | | | | | | | | | - Andrea Di Stasio
- Urologia, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | - Elisabetta Garibaldi
- Radioterapia, PO Umberto Parini, Aosta, Italy
- Radioterapia, Istituto di Candiolo-Fondazione del Piemonte per l’Oncologia (FPO), IRCCS, Candiolo, Italy
| | | | | | | | | | - Luca Molinaro
- Anatomia Patologica 1U, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Gabriele Montefusco
- Urologia, AOU Città della Salute e della Scienza e Università di Torino, Torino, Italy
| | | | | | | | | | | | - Armando Serao
- Urologia, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | | | | | - Alessandro Volpe
- Urologia, AOU Maggiore della Carità e Università del Piemonte Orientale, Novara, Italy
| | | | | | - Andrea Zitella
- Urologia, AOU Città della Salute e della Scienza e Università di Torino, Torino, Italy
| | - Enrico Bollito
- Anatomia Patologica, AOU San Luigi Gonzaga e Università di Torino, Orbassano, Italy
| | - Paolo Gontero
- Urologia, AOU Città della Salute e della Scienza e Università di Torino, Torino, Italy
| | | | - Claudia Galassi
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Oscar Bertetto
- Rete Oncologica del Piemonte e Valle d’Aosta, AOU Città della Salute e della Scienza di Torino, Torino, Italy
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5
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Lunger L, Meissner VH, Kopp BCG, Dinkel A, Schiele S, Ankerst DP, Gschwend JE, Herkommer K. Prevalence and determinants of decision regret in long-term prostate cancer survivors following radical prostatectomy. BMC Urol 2023; 23:139. [PMID: 37612591 PMCID: PMC10464370 DOI: 10.1186/s12894-023-01311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Patients with localized prostate cancer (PC) are faced with a wide spectrum of therapeutic options at initial diagnosis. Following radical prostatectomy (RP), PC patients may experience regret regarding their initial choice of treatment, especially when oncological and functional outcomes are poor. Impacts of psychosocial factors on decision regret, especially after long-term follow-up, are not well understood. This study aimed to investigate the prevalence and determinants of decision regret in long-term PC survivors following RP. METHODS 3408 PC survivors (mean age 78.8 years, SD = 6.5) from the multicenter German Familial PC Database returned questionnaires after an average of 16.5 (SD = 3.8) years following RP. The outcome of decision regret concerning the initial choice of RP was assessed with one item from the Decision Regret Scale. Health-related quality of life (HRQoL), PC-anxiety, PSA-anxiety, as well as anxiety and depressive symptoms were considered for independent association with decision regret via multivariable logistic regression. RESULTS 10.9% (373/3408) of PC survivors reported decision regret. Organ-confined disease at RP (OR 1.39, 95%CI 1.02-1.91), biochemical recurrence (OR 1.34, 1.00-1.80), low HRQoL (OR 1.69,1.28-2.24), depressive symptoms (OR 2.32, 1.52-3.53), and prevalent PSA anxiety (OR 1.88,1.17-3.01) were significantly associated with increased risk of decision regret. Shared decision-making reduced the odds of decision regret by 40% (OR 0.59, 0.41-0.86). CONCLUSIONS PC survivors may experience decision regret even after 16 years following RP. Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret. Awareness regarding patients showing depressive symptoms or PSA anxiety should be encouraged to identify patients at risk of decision regret in need of additional psychological support.
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Affiliation(s)
- Lukas Lunger
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Valentin H Meissner
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt C G Kopp
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Schiele
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Donna P Ankerst
- Departments of Mathematics and Life Science Systems, Munich Data Science Institute, Technical University of Munich, Garching, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
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Chhatre S, Gallo JJ, Guzzo T, Morales KH, Newman DK, Vapiwala N, Van Arsdalen K, Wein AJ, Malkowicz SB, Jayadevappa R. Trajectory of Depression among Prostate Cancer Patients: A Secondary Analysis of a Randomized Controlled Trial. Cancers (Basel) 2023; 15:cancers15072124. [PMID: 37046786 PMCID: PMC10092991 DOI: 10.3390/cancers15072124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Background: While psychological difficulties, such as depression, among prostate cancer patients are known, their longitudinal burden remains understudied. We assessed the burden of depression across low-, intermediate- and high-risk prostate cancer groups, and the association between regret and long-term depression. Methods: Secondary analysis of data from a multi-centered randomized controlled study among localized prostate cancer patients was carried out. Assessments were performed at baseline, and at 3-, 6-, 12- and 24-month follow-up. Depression was assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. A CES-D score ≥ 16 indicates high depression. Regret was measured using the regret scale of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). The proportion of patients with high depression was compared over time, for each risk category. Logistic regression was used to assess the association between regret, and long-term depression after adjusting for age, race, insurance, smoking status, marital status, income, education, employment, treatment, number of people in the household and study site. Results: The study had 743 localized prostate cancer patients. Median depression scores at 6, 12 and 24 months were significantly larger than the baseline median score, overall and for the three prostate cancer risk groups. The proportion of participants with high depression increased over time for all risk groups. Higher regret at 24-month follow-up was significantly associated with high depression at 24-month follow-up, after adjusting for covariates. Conclusions: A substantial proportion of localized prostate cancer patients continued to experience long-term depression. Patient-centered survivorship care strategies can help reduce depression and regret, and improve outcomes in prostate cancer care.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph J. Gallo
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Thomas Guzzo
- Urology Division, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Knashawn H. Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Diane K. Newman
- Urology Division, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Keith Van Arsdalen
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA 19104, USA
- Urology Division, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alan J. Wein
- Urology Division, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Stanley Bruce Malkowicz
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA 19104, USA
- Urology Division, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ravishankar Jayadevappa
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Urology Division, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
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7
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Ghoreifi A, Kaneko M, Peretsman S, Iwata A, Brooks J, Shakir A, Sugano D, Cai J, Cacciamani G, Park D, Lebastchi AH, Ukimura O, Bahn D, Gill I, Abreu AL. Patient-reported Satisfaction and Regret Following Focal Therapy for Prostate Cancer: A Prospective Multicenter Evaluation. EUR UROL SUPPL 2023; 50:10-16. [PMID: 37101771 PMCID: PMC10123415 DOI: 10.1016/j.euros.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
Background Several reports are available regarding the treatment decision regret of patients receiving conventional treatments for localized prostate cancer (PCa); yet data on patients undergoing focal therapy (FT) are sparse. Objective To evaluate the treatment decision satisfaction and regret among patients who underwent FT for PCa with high-intensity focused ultrasound (HIFU) or cryoablation (CRYO). Design setting and participants We identified consecutive patients who underwent HIFU or CRYO FT as the primary treatment for localized PCa at three US institutions. A survey with validated questionnaires, including the five-question Decision Regret Scale (DRS), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5), was mailed to the patients. The regret score was calculated based on the five items of the DRS, and regret was defined as a DRS score of >25. Outcome measurements and statistical analysis Multivariable logistic regression models were applied to assess the predictors of treatment decision regret. Results and limitations Of 236 patients, 143 (61%) responded to the survey. Baseline characteristics were similar between responders and nonresponders. During a median (interquartile range) follow-up of 43 (26-68) mo, the treatment decision regret rate was 19.6%. On a multivariable analysis, higher prostate-specific antigen (PSA) at nadir after FT (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.1-2, p = 0.009), presence of PCa on follow-up biopsy (OR 3.98, 95% CI 1.5-10.6, p = 0.006), higher post-FT IPSS (OR 1.18, 95% CI 1.01-1.37, p = 0.03), and newly diagnosed impotence (OR 6.67, 95% CI 1.57-27, p = 0.03) were independent predictors of treatment regret. The type of energy treatment (HIFU/CRYO) was not a predictor of regret/satisfaction. Limitations include retrospective abstraction. Conclusions FT for localized PCa is well accepted by the patients, with a low regret rate. Higher PSA at nadir, presence of cancer on follow-up biopsy, bothersome postoperative urinary symptoms, and impotence after FT were independent predictors of treatment decision regret. Patient summary In this report, we looked at the factors affecting satisfaction and regret in patients with prostate cancer undergoing focal therapy. We found that focal therapy is well accepted by the patients, while presence of cancer on follow-up biopsy as well as bothersome urinary symptoms and sexual dysfunction can predict treatment decision regret.
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8
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George DJ, Mohamed AF, Tsai JH, Karimi M, Ning N, Jayade S, Botteman M. Understanding what matters to metastatic castration-resistant prostate cancer (mCRPC) patients when considering treatment options: A US patient preference survey. Cancer Med 2023; 12:6040-6055. [PMID: 36226867 PMCID: PMC10028042 DOI: 10.1002/cam4.5313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Understanding how patients perceive the efficacy, safety, and administrative burden of treatments for metastatic castration-resistant prostate cancer (mCRPC) can facilitate shared-decision making for optimal management. This study sought to elicit patient preferences for mCRPC treatments in the US. METHODS We conducted a cross-sectional survey using the discrete-choice experiment method. Participants were asked to state their choices over successive sets of treatment alternatives, defined by varying levels of treatment attributes: overall survival (OS), months until patients develop a fracture or bone metastasis, likelihood of requiring radiation to control bone pain, fatigue, nausea, and administration (i.e., oral/IV injection/IV infusion). Using mixed logit models, we determined the value (i.e., preference weights) that respondents placed on each attribute. Relative attribute importance (RAI) and marginal rates of substitution (MRS) were calculated to understand patients' willingness to make tradeoffs among different attributes. RESULTS The final data set numbered 160 participants, with a mean age of 71.6 years old and a mean of 8.96 years since prostate cancer diagnosis. Participants' treatment preferences were as follows: OS (RAI: 31%), bone pain control (23%), nausea (16%), delaying fracture or bone metastasis (15%), fatigue (11%), and administration (3%). The MRS demonstrated that respondents were willing to trade 1.9 months of OS to eliminate moderate nausea and 3.3 months of OS for a reduction in fatigue from severe to mild. CONCLUSIONS Improving OS is the highest priority for patients with mCRPC, but they are willing to trade some survival to reduce the risk of requiring radiation to control bone pain, delay a fracture or bone metastasis, and experience less severe nausea and fatigue.
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Affiliation(s)
- Daniel J George
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jui-Hua Tsai
- Evidence and Access, OPEN Health, Parsippany, New Jersey, USA
| | - Milad Karimi
- Evidence and Access, OPEN Health, Rotterdam, The Netherlands
| | - Ning Ning
- Evidence and Access, OPEN Health, Parsippany, New Jersey, USA
| | - Sayeli Jayade
- Evidence and Access, OPEN Health, Parsippany, New Jersey, USA
| | - Marc Botteman
- Evidence and Access, OPEN Health, Parsippany, New Jersey, USA
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9
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Todio E, Sharp J, Morrow A, Taylor N, Schofield P, Mazariego C. Examining the effectiveness and implementation of patient treatment decision-aid tools for men with localised prostate cancer: A systematic review. Psychooncology 2023; 32:469-491. [PMID: 36610001 DOI: 10.1002/pon.6094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/19/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Men diagnosed with localised prostate cancer (LPC) often face a difficult process deciding on a treatment choice that suits their personal preferences. This systematic review examines the impact of patient treatment decision-aids (DAs) on decisional outcomes and treatment choice for men diagnosed with LPC. Our secondary aim was to examine how DAs have been implemented into routine clinical practice. METHODS A systematic search was conducted up to June 2022 using the following databases: Medline, Embase, PsycINFO, CINAHL, Cochrane, Scopus, and Web of Science. Articles were included if they evaluated the effectiveness of treatment DAs for LPC patients on various decisional outcomes and treatment choice. The Mixed-Method Appraisal Tool was used to assess methodological quality and risk of bias. Data on implementation outcomes were also extracted if reported. RESULTS Twenty-four articles were included for the analysis (seven non-randomised studies, 16 randomised control trials, and one qualitative study). Results showed DAs have the potential to improve patient knowledge but revealed no effects on decisional regret or preparedness in decision-making. Due to the variability in methodology among studies, results varied widely for treatment choice, decision-making involvement, decisional conflict, and treatment decision satisfaction. At least one implementation outcome was reported in 11 of the included studies, with the most commonly assessed outcomes being acceptability and appropriateness. CONCLUSIONS While DAs appear to improve knowledge, further qualitative evaluations and standardised assessments are needed to better understand men's experiences using DAs and to determine advantages and optimal ways to implement DAs into the treatment decision-making pathway.
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Affiliation(s)
- Elizabeth Todio
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Jessica Sharp
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - April Morrow
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Natalie Taylor
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia.,Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Victoria, Australia.,Behavioural Sciences Unit, Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Carolyn Mazariego
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia.,The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Camperdown, New South Wales, Australia
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10
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Adapting a patient-centered communication tool for older patients with acute myeloid leukemia and their oncologist. Blood Adv 2022; 6:5707-5710. [PMID: 35930701 PMCID: PMC9618777 DOI: 10.1182/bloodadvances.2022008041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023] Open
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11
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Development of a Quantitative Instrument to Elicit Patient Preferences for Person-Centered Dementia Care Stage 1: A Formative Qualitative Study to Identify Patient Relevant Criteria for Experimental Design of an Analytic Hierarchy Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137629. [PMID: 35805286 PMCID: PMC9266267 DOI: 10.3390/ijerph19137629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 01/19/2023]
Abstract
Background: Person-centered care (PCC) requires knowledge about patient preferences. This formative qualitative study aimed to identify (sub)criteria of PCC for the design of a quantitative, choice-based instrument to elicit patient preferences for person-centered dementia care. Method: Interviews were conducted with n = 2 dementia care managers, n = 10 People living with Dementia (PlwD), and n = 3 caregivers (CGs), which followed a semi-structured interview guide including a card game with PCC criteria identified from the literature. Criteria cards were shown to explore the PlwD’s conception. PlwD were asked to rank the cards to identify patient-relevant criteria of PCC. Audios were verbatim-transcribed and analyzed with qualitative content analysis. Card game results were coded on a 10-point-scale, and sums and means for criteria were calculated. Results: Six criteria with two sub-criteria emerged from the analysis; social relationships (indirect contact, direct contact), cognitive training (passive, active), organization of care (decentralized structures and no shared decision making, centralized structures and shared decision making), assistance with daily activities (professional, family member), characteristics of care professionals (empathy, education and work experience) and physical activities (alone, group). Dementia-sensitive wording and balance between comprehensibility vs. completeness of the (sub)criteria emerged as additional themes. Conclusions: Our formative study provides initial data about patient-relevant criteria of PCC to design a quantitative patient preference instrument. Future research may want to consider the balance between (sub)criteria comprehensibility vs. completeness.
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12
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Ihrig A, Maatouk I, Friederich HC, Baunacke M, Groeben C, Koch R, Thomas C, Huber J. The Treatment Decision-making Preferences of Patients with Prostate Cancer Should Be Recorded in Research and Clinical Routine: a Pooled Analysis of Four Survey Studies with 7169 Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:675-682. [PMID: 32940881 PMCID: PMC9205804 DOI: 10.1007/s13187-020-01867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 05/13/2023]
Abstract
Different patients want to take different roles in the treatment decision-making process; these roles can be classified as passive, collaborative, and active. The aim of this study was to investigate the correlation between decision-making preferences among patients with prostate cancer and personal, disease-related, and structural factors. In four survey studies, we asked 7169 prostate cancer patients about their decision-making preferences using the Control Preferences Scale (CPS) and collected clinical, psychological, and quality-of-life measures. Most patients (62.2%) preferred collaborative decision-making, while 2322 (32.4%) preferred an active role, and only 391 (5.5%) preferred a passive role. Age (p < 0.001), data collection mode (p < 0.001), peer-to-peer support (p = 0.018), treatment status (p < 0.001), performed or planned radical prostatectomy (p < 0.001), metastatic disease (p = 0.001), and quality of life (p < 0.001) showed significant associations with patients' preferred decision-making roles. Oncologic risk group, anxiety, and depression were not significant in the model. In particular, younger prostate cancer patients with higher quality of life completing an online survey want to play a more active role in treatment decision-making. Before treatment has started, patients tend to prefer collaborative decision-making. Few prostate cancer patients in Germany prefer a passive role. These patients are mostly older patients, patients with a metastatic disease, and patients who have opted for prostatectomy. Whether this finding reflects a generational effect or a tendency by age group and disease phase should be investigated. Further research is also needed to describe the causalities of these relationships. The CPS offers valuable information for personal counselling and should be applied in clinical routine. In a large group of patients with prostate cancer, we found that there is a strong desire for joint decision-making with the physician before the actual treatment. Especially younger men, men with active online behaviour, and men with a high quality of life want to be actively involved in therapy decision-making processes.
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Affiliation(s)
- Andreas Ihrig
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - I Maatouk
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - H C Friederich
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - M Baunacke
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - C Groeben
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Koch
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - C Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - J Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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13
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Patient Engagement in the Management of Benign Prostatic Hyperplasia. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Reddy S, Noel J, Moschovas M, Bhat KRS, Perera R, Rogers TP, Stirt D, Doss J, Jenson C, Andrich J, Patel V. Same Day Discharge Protocol for Robotic Assisted Radical Prostatectomy: the experience of a High-Volume Referral Center. J Endourol 2022; 36:934-940. [PMID: 35166120 DOI: 10.1089/end.2021.0730] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective As the COVID-19 global pandemic continues, there is increased value in performing same-day discharge (SDD) protocols to minimize viral exposure and maintain the appropriate surgical treatment for oncological patients. In this scenario, we performed a prospective analysis of outcomes of our patients undergoing SDD protocol after robotic-assisted radical prostatectomy (RARP). Material and Methods The SDD criteria included patients with no intraoperative complications, stable postoperative hemoglobin levels (compared to preoperative values), stable vital signs, normal urine output, ambulation with assistance and independently without dizziness, tolerance of clear liquids without nausea or vomiting, pain control with oral medication, and patient/family confidence with SDD. Patients older than 70 years, concomitant general surgery operations, multiple comorbidities, and complex procedures such as salvage surgery were excluded from our protocol. Results Of the 101 patients who met the criteria for SDD, 73 (72%) had a successful SDD. All SDF (Same day discharge failure) patients were discharged one day after surgery. Intraoperative characteristics were not statistically different with a median operative time of 92 (81-107) vs 103 (91-111) minutes for SDD and SDF respectively. Of the 28 SDF patients, the most common reasons for staying were anesthesia-related factors of nausea (35%), drowsiness (7%), patient/caregiver preference (25%), pain (14%), labile blood pressure (7%), arrhythmia (7%), and dizziness (7%). There was no significant difference in readmission rates, complication rates, or post-operative pain scores between SDD and SDF patients. Conclusions In our experience, SDD for patients undergoing RARP can be safely and feasibly incorporated into a clinical care pathway without increasing readmission rates. We were successful in 72% of cases due to coordinated care between anesthetics, nursing staff, and appropriate patient selection. We also believe that incorporating pre-and postoperative patient education and assurance is crucial to minimize their exposure to COVID-19 during the surgical treatment for prostate cancer.
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Affiliation(s)
- Sunil Reddy
- Global Robotic Institute, Urology, Celebration, Florida, United States;
| | - Jonathan Noel
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States;
| | - Marcio Moschovas
- AdventHealth, 6245, Urology, Celebration, Florida, United States;
| | - Kulthe Ramesh Seetharam Bhat
- AdventHealth Global Robotics Institute, Urology, 400 Celebration place, suite 200, celebration, Florida, United States, 34747.,Global robotics institute;
| | - Roshane Perera
- University of Florida, 3463, Gainesville, Florida, United States;
| | - Travis Phillip Rogers
- Florida Hospital Celebration Health, 23067, 410 Celebration Pl, Celebration, Florida, United States, 34747-4970.,United States;
| | - Daniel Stirt
- University of Central Florida, 6243, Medicine, Orlando, Florida, United States;
| | - Janice Doss
- Adventhealth Global Robotics Institute, Florida, United States;
| | - Cathy Jenson
- Florida Hospital Celebration Health, 23067, 410 Celebration p, Suite 200, Celebration, Florida, United States, 34747;
| | - John Andrich
- Adventhealth Global Robotics Institute, Florida, United States;
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States;
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15
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Rahota RG, Salin A, Gautier JR, Almeras C, Garnault V, Tollon C, Loison G, Beauval JB, Ploussard G. A prehabilitation programme implemented before robot-assisted radical prostatectomy improves peri-operative outcomes and continence recovery. BJU Int 2021; 130:357-363. [PMID: 34854212 DOI: 10.1111/bju.15666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the impact of a routine, on-site, 1-day prehabilitation (PreHab) programme on peri-operative and continence recovery after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS All 303 consecutive RARPs performed between March 2018 and February 2020 since the routine implementation of PreHab were included in our study. PreHab was carried out according to the availability of the 1-day programme before the planned date of surgery (two sessions per month including four patients per session). The PreHab programme was implemented in 165 patients (54.5%). The primary endpoint was continence recovery, strictly defined as no safety pad use at 1 and 6 months. Secondary endpoints were peri-operative variables (blood loss, operating time, length of stay, transfusion, complications, and readmission rates). Comparisons were made according to whether the PreHab pathway was applied or not (PreHab+ vs PreHab-) in univariable and multivariable models. RESULTS The PreHab pathway was implemented for a stable proportion of patients over time (54.5%). The two cohorts were comparable in terms of preoperative and pathological features (P > 0.05). Length of stay was significantly shorter in the PreHab+ group (1.3 vs 1.9 days; P = 0.001). There was a trend towards fewer complications in the PreHab+ group (P = 0.061). Use of the PreHab pathway was independently correlated with higher continence rates at 1 month (37% vs 60%; P < 0.001) and 6 months (67.4% vs 87.3%; P < 0.001), even after controlling for age, body mass index, prostate volume, type of apical reconstruction, nerve-sparing surgery and lymph node dissection. The main limitation of the study was the absence of randomization. CONCLUSIONS Our experience demonstrates that the PreHab programme is the major predictor of improved peri-operative outcomes and continence recovery after RARP, with sustainable benefits 6 months after surgery.
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Affiliation(s)
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | | | - Valérie Garnault
- Public Health Department, PMSI, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
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Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, Boland L, Dunn S, Dwyer AA, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Rutherford C, Zhao J, Rader T, Graham ID, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev 2021; 11:CD013385. [PMID: 34749427 PMCID: PMC8575556 DOI: 10.1002/14651858.cd013385.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching. OBJECTIVES To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects. SEARCH METHODS We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence. MAIN RESULTS Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low. AUTHORS' CONCLUSIONS Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
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Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | - Anne C Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lubeck, Lubeck, Germany
| | - Laura Boland
- Integrated Knowledge Translation Research Network, The Ottawa Hospital Research Institute, Ottawa, Canada
- Western University, London, Canada
| | - Sandra Dunn
- BORN Ontario, CHEO Research Institute, School of Nursing, University of Ottawa, Ottawa, Canada
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston University, Chestnut Hill, Massachusetts, USA
- Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simone Maria Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Claudia Rutherford
- School of Psychology, Quality of Life Office, University of Sydney, Camperdown, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
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17
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Survivors' preferences for the organization and delivery of supportive care after treatment: An integrative review. Eur J Oncol Nurs 2021; 54:102040. [PMID: 34571444 DOI: 10.1016/j.ejon.2021.102040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Quality supportive care during cancer survivorship contributes to positive physical and psychosocial health. However, the potential positive impacts are influenced by survivors' perceptions of and ability to access the supportive care services that they deem important to their well-being. The purpose of this integrative review was to examine cancer survivors' preferences for the organization and delivery of supportive care services in the post-treatment period. METHODS We conducted a systematic search for relevant quantitative, qualitative and mixed methods studies. Included studies were analyzed using directed content analysis, focused on models of care and type of provider, site of care, specialized services, structural supports through transitions, and sources of information. RESULTS Sixty-nine studies were included. Overall, survivors' preferences are not static and fluctuate over time based on their perceived health needs, concerns and points of transition in care. While specialist supportive care led by consultant oncologists is often identified as the preferred model of care, survivors' also express preferences for integrated and shared models of care, involving oncology nurses, primary care and multidisciplinary professionals to optimise coordination and impact of supportive care. Flexibility in care delivery, leveraging technology and expertise, was preferred to ensure convenient and timely access to supportive care. CONCLUSIONS Cancer survivors express preferences for the organization and delivery of supportive care in the post-treatment phase that fluctuate based on their perceived health needs. The development of novel survivorship health services must consider survivors' preferences and allow flexibility in care delivery to facilitate engagement, uptake, and effectiveness.
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18
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Gonzalez JM, Reed SD, Johnson FR. Stratified psoriasis treatment plans: why is patient preference information needed? Br J Dermatol 2021; 185:882-883. [PMID: 34463961 DOI: 10.1111/bjd.20697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- J M Gonzalez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - S D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - F R Johnson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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19
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Grüne B, Kriegmair MC, Lenhart M, Michel MS, Huber J, Köther AK, Büdenbender B, Alpers GW. Decision Aids for Shared Decision-making in Uro-oncology: A Systematic Review. Eur Urol Focus 2021; 8:851-869. [PMID: 33980474 DOI: 10.1016/j.euf.2021.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/17/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Decision aids (DAs) aim to support patients in the process of shared decision-making for complex treatment decisions. To improve patient-centered care in uro-oncology, it is essential to evaluate the availability and quality of existing DAs. OBJECTIVE To assess the quality of existing DAs for patients across the most prevalent uro-oncological entities. EVIDENCE ACQUISITION This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A systematic literature search (MedLine, Cochrane Library, Web of Science Core Collection, and CCMed) was conducted to identify DAs for treatment decisions for patients with prostate, renal, or bladder cancer. All studies reporting on the development or evaluation of DAs were included. The DAs were examined based on the International Patient Decision Aid Standards (IPDAS) and the evaluation studies were compared in accordance with Standards for Universal reporting of a patient Decision Aid Evaluations (SUNDAE). EVIDENCE SYNTHESIS The literature search identified 1995 potentially relevant publications. Thirty-two studies reporting on 25 DAs met the inclusion criteria. Twenty-two DAs address prostate cancer, two renal tumor, and one bladder cancer. In the majority of DAs (n = 20), patients can enter individual data. A few (n = 6) DAs allow for personalization using a risk-adapted presentation of treatment options. The percentage of IPDAS criteria met in DAs ranged between 50% and 100% (median 87.5%), and the studies' adherence to the SUNDAE checklist was between 62% and 96% (median 86.6%). Evaluation studies suggest that interventions are likely efficacious. However, a preliminary meta-analysis revealed no significant difference between "DA" and "usual care" for decisional conflict or decisional regret. CONCLUSIONS This review highlights that a number of well-developed DAs exist in urology. However, there is a need for specific instruments targeting kidney and bladder cancer. Personalization of tools and adherence to international standards of DAs should be further improved. PATIENT SUMMARY The majority of uro-oncological decision aids target prostate cancer, whereas fewer address kidney or bladder cancer. The quality of the existing instruments is high, but can be increased further to better address specific needs of individual patients.
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Affiliation(s)
- Britta Grüne
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Maximilian Lenhart
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice S Michel
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Anja K Köther
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Björn Büdenbender
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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Krueger E, Secinti E, Wu W, Hanna N, Durm G, Einhorn L, Jalal S, Mosher CE. Measurement of patients' acceptable symptom levels and priorities for symptom improvement in advanced lung cancer. Support Care Cancer 2021; 29:5895-5904. [PMID: 33763726 DOI: 10.1007/s00520-021-06159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Little research has assessed cancer patients' success criteria and priorities for symptom improvement to inform patient-centered care. Thus, we modified and tested a measure of these constructs for advanced lung cancer patients. We compared acceptable severity levels following symptom treatment across eight symptoms and identified patient subgroups based on symptom importance. METHODS Advanced lung cancer patients (N=102) completed a one-time survey, including the modified Patient-Centered Outcomes Questionnaire (PCOQ), standard symptom measures, and other clinical characteristics. RESULTS The modified PCOQ showed evidence of construct validity through associations with theoretically related constructs. Symptom severity and importance were moderately correlated. Levels of acceptable symptom severity were low and did not differ across the eight symptoms. Four patient subgroups were identified: (1) those who rated all symptoms as low in importance (n=12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (n=29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (n=23); and (4) those who rated all symptoms as highly important (n=33). Subgroups were unrelated to clinical characteristics, except for functional status. CONCLUSION The modified PCOQ showed evidence of construct validity. Patients considered low symptom severity to be acceptable, irrespective of the symptom. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Patients have heterogeneous priorities for symptom improvement, which has implications for tailoring treatment.
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Affiliation(s)
- Ellen Krueger
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA.
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Nasser Hanna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory Durm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lawrence Einhorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shadia Jalal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
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Paudel R, Ferrante S, Woodford J, Maitland C, Stockall E, Maatman T, Lane GI, Berry DL, Sales AE, Montie JE. Implementation of prostate cancer treatment decision aid in Michigan: a qualitative study. Implement Sci Commun 2021; 2:27. [PMID: 33676583 PMCID: PMC7936475 DOI: 10.1186/s43058-021-00125-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/05/2021] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Roshan Paudel
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - Stephanie Ferrante
- Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI USA
| | | | | | | | | | - Giulia I. Lane
- Department of Urology, University of Michigan, Ann Arbor, MI USA
| | - Donna L. Berry
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA USA
| | - Anne E. Sales
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - James E. Montie
- Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI USA
| | - for the Michigan Urological Surgery Improvement Collaborative (MUSIC), Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
- Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI USA
- University of Michigan, Ann Arbor, MI USA
- Sherwood Medical Center, Detroit, MI USA
- Capital Urological Associates, Okemos, MI USA
- Michigan Urological Clinic, Grand Rapids, MI USA
- Department of Urology, University of Michigan, Ann Arbor, MI USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA USA
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Chandrasekar T, Boorjian SA, Capitanio U, Gershman B, Mir MC, Kutikov A. Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass. Eur Urol 2021; 80:575-588. [PMID: 33558091 DOI: 10.1016/j.eururo.2021.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. OBJECTIVE To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. CONCLUSIONS Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. PATIENT SUMMARY With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Berry DL, Hong F, Blonquist TM, Halpenny B, Xiong N, Filson CP, Master VA, Sanda MG, Chang P, Chien GW, Jones RA, Krupski TL, Wolpin S, Wilson L, Hayes JH, Trinh QD, Sokoloff M. Decision regret, adverse outcomes, and treatment choice in men with localized prostate cancer: Results from a multi-site randomized trial. Urol Oncol 2020; 39:493.e9-493.e15. [PMID: 33353864 DOI: 10.1016/j.urolonc.2020.11.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Men diagnosed with localized prostate cancer must navigate a highly preference-sensitive decision between treatment options with varying adverse outcome profiles. We evaluated whether use of a decision support tool previously shown to decrease decisional conflict also impacted the secondary outcome of post-treatment decision regret. METHODS Participants were randomized to receive personalized decision support via the Personal Patient Profile-Prostate or usual care prior to a final treatment decision. Symptoms were measured just before randomization and 6 months later; decision regret was measured at 6 months along with records review to ascertain treatment choices. Regression modeling explored associations between baseline variables including race and D`Amico risk, study group, and 6-month variables regret, choice, and symptoms. RESULTS At 6 months, 287 of 392 (73%) men returned questionnaires of which 257 (89%) had made a treatment choice. Of that group, 201 of 257 (78%) completely answered the regret scale. Regret was not significantly different between participants randomized to the P3P intervention compared to the control group (P = 0.360). In univariate analyses, we found that Black men, men with hormonal symptoms, and men with bowel symptoms reported significantly higher decision regret (all P < 0.01). Significant interactions were detected between race and study group (intervention vs. usual care) in the multivariable model; use of the Personal Patient Profile-Prostate was associated with significantly decreased decisional regret among Black men (P = 0.037). Interactions between regret, symptoms and treatment revealed that (1) men choosing definitive treatment and reporting no hormonal symptoms reported lower regret compared to all others; and (2) men choosing active surveillance and reporting bowel symptoms had higher regret compared to all others. CONCLUSION The Personal Patient Profile-Prostate decision support tool may be most beneficial in minimizing decisional regret for Black men considering treatment options for newly-diagnosed prostate cancer. TRIAL REGISTRATION NCT01844999.
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Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Nursing, Seattle, WA.
| | | | | | | | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA
| | | | - Seth Wolpin
- University of Washington School of Nursing, Seattle, WA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Julia H Hayes
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Mitchell Sokoloff
- Department of Urology, University of Massachusetts Medical Center, Worchester, MA
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Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. JAMA Netw Open 2020; 3:e2028320. [PMID: 33289846 PMCID: PMC7724561 DOI: 10.1001/jamanetworkopen.2020.28320] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE There is a lack of data evaluating the association of surgical delay time (SDT) with outcomes in patients with localized, high-risk prostate cancer. OBJECTIVE To investigate the association of SDT of radical prostatectomy and final pathological and survival outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the US National Cancer Database (NCDB) and identified all patients with clinically localized (cT1-2cN0cM0) high-risk prostate adenocarcinoma diagnosed between 2006 and 2016 who underwent radical prostatectomy. Data analyses were performed from April 1 to April 12, 2020. EXPOSURES SDT was defined as the number of days between the initial cancer diagnosis and radical prostatectomy. SDT was categorized into 5 groups: 31 to 60, 61 to 90, 91 to 120, 121 to 150, and 151 to 180 days. MAIN OUTCOMES AND MEASURES The primary outcomes were predetermined as adverse pathological outcomes after radical prostatectomy, including pT3-T4 disease, pN-positive disease, and positive surgical margin. The adverse pathological score (APS) was defined as an accumulated score of the 3 outcomes (0-3). An APS of 2 or higher was considered a separate outcome to capture cases with more aggressive pathological features. The secondary outcome was overall survival. RESULTS Of the 32 184 patients included in the study, the median (interquartile range) age was 64 (59-68) years, and 25 548 (79.4%) were non-Hispanic White. Compared with an SDT of 31 to 60 days, longer SDTs were not associated with higher risks of having any adverse pathological outcomes (odds ratio [OR], 0.95; 95% CI, 0.80-1.12; P = .53), pT3-T4 disease (OR, 0.99; 95% CI, 0.83-1.17; P = .87), pN-positive disease (OR, 0.79; 95% CI, 0.59-1.06; P = .12), positive surgical margin (OR, 0.88; 95% CI, 0.74-1.05; P = .17), or APS greater than or equal to 2 (OR, 0.90; 95% CI, 0.74-1.05; P = .17). Longer SDT was also not associated with worse overall survival (for SDT of 151-180 days, hazard ratio, 1.12; 95% CI, 0.79-1.59, P = .53). Subgroup analyses performed for patients with very high-risk disease (primary Gleason score 5) and sensitivity analyses with SDT considered as a continuous variable yielded similar results. CONCLUSIONS AND RELEVANCE In this cohort study of patients who underwent radical prostatectomy within 180 days of diagnosis for high-risk prostate cancer, radical prostatectomy for high-risk prostate cancer could be safely delayed up to 6 months after diagnosis.
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Affiliation(s)
- Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Ruchika Talwar
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Raju R. Chelluri
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Thomas J. Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Daniel J. Lee
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Naunheim MR, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology Part XII: Assessing Patient Preferences. Otolaryngol Head Neck Surg 2020; 164:473-481. [PMID: 32895002 DOI: 10.1177/0194599820950723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a contemporary resource to update clinicians and researchers on the current state of assessment of patient preferences. DATA SOURCES Published studies and literature regarding patient preferences, evidence-based practice, and patient-centered management in otolaryngology. REVIEW METHODS Patients make choices based on both physician input and their own preferences. These preferences are informed by personal values and attitudes, and they ideally result from a deliberative evaluation of the risks, benefits, and other outcomes pertaining to medical care. To date, rigorous evaluation of patient preferences for otolaryngologic conditions has not been integrated into clinical practice or research. This installment of the "Evidence-Based Medicine in Otolaryngology" series focuses on formal assessment of patient preferences and the optimal methods to determine them. CONCLUSIONS Methods have been developed to optimize our understanding of patient preferences. IMPLICATIONS FOR PRACTICE Understanding these patient preferences may help promote an evidence-based approach to the care of individual patients.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Ploussard G, Loison G, Almeras C, Gautier JR, Cazali P, Tollon C, Beauval JB, Salin A. One-day Prehabilitation Program Before Robotic Radical Prostatectomy in Daily Practice: Routine Feasibility and Benefits for Patients and Hospitals. EUR UROL SUPPL 2020; 21:14-16. [PMID: 34337463 PMCID: PMC8317858 DOI: 10.1016/j.euros.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Guillaume Loison
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Almeras
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Priscilla Cazali
- Prehabilitation Program, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Ambroise Salin
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
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Collée GE, van der Wilk BJ, van Lanschot JJB, Busschbach JJ, Timmermans L, Lagarde SM, Kranenburg LW. Interventions that Facilitate Shared Decision-Making in Cancers with Active Surveillance as Treatment Option: a Systematic Review of Literature. Curr Oncol Rep 2020; 22:101. [PMID: 32725550 PMCID: PMC7387328 DOI: 10.1007/s11912-020-00962-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Medical decisions concerning active surveillance are complex, especially when evidence on superiority of one of the treatments is lacking. Decision aids have been developed to facilitate shared decision-making on whether to pursue an active surveillance strategy. However, it is unclear how these decision aids are designed and which outcomes are considered relevant. The purpose of this study is to systematically review all decision aids in the field of oncological active surveillance strategies and outcomes used by authors to assess their efficacy. RECENT FINDINGS A search was performed in Embase, Medline, Web of Science, Cochrane, PsycINFO Ovid and Google Scholar until June 2019. Eligible studies concerned interventions aiming to facilitate shared decision-making for patients confronted with several treatment alternatives, with active surveillance being one of the treatment alternatives. Twenty-three eligible articles were included. Twenty-one articles included patients with prostate cancer, one with thyroid cancer and one with ovarian cancer. Interventions mostly consisted of an interactive web-based decision aid format. After categorization of outcomes, seven main groups were identified: knowledge, involvement in decision-making, decisional conflict, treatment preference, decision regret, anxiety and health-related outcomes. Although active surveillance has been implemented for several malignancies, interventions that facilitate shared decision-making between active surveillance and other equally effective treatment alternatives are scarce. Future research should focus on developing interventions for malignancies like rectal cancer and oesophageal cancer as well. The efficacy of interventions is mostly assessed using short-term outcomes.
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Affiliation(s)
- G E Collée
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
| | - B J van der Wilk
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands.
| | - J J B van Lanschot
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands
| | - J J Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
| | - L Timmermans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands
| | - L W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
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28
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Ploussard G, Almeras C, Beauval JB, Gautier JR, Garnault V, Frémont N, Dallemagne S, Loison G, Salin A, Tollon C. A combination of enhanced recovery after surgery and prehabilitation pathways improves perioperative outcomes and costs for robotic radical prostatectomy. Cancer 2020; 126:4148-4155. [PMID: 32639601 DOI: 10.1002/cncr.33061] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND An enhanced recovery after surgery (ERAS) pathway has shown benefit in oncologic surgery. However, literature is scarce regarding the impact of this pathway, alone or combined with prehabilitation (PreHab) programs, on outcomes after robot-assisted radical prostatectomy (RARP). METHODS Included in this study were 507 consecutive patients undergoing RARP from 2014 to 2019. The primary endpoint was duration of hospital stay. Secondary outcomes included intraoperative blood loss, operative duration, readmission rate, and overall costs. Univariate and multivariate comparisons were performed according to the ERAS and PreHab program status. RESULTS ERAS patients had shorter hospital stays (P < .001), reduced operative times (P < .001), and decreased blood loss (P < .001) in comparison with non-ERAS patients. Shorter hospital stays were not associated with an increased readmission rate (7.9% [stable over time]; P = .757). Patients from an ERAS-/PreHab- group had a longer hospital stay (4.7 days) than those from an ERAS+/PreHab- group (3.5 days) and those from an ERAS+/PreHab+ group (1.6 days; P < .001). In a multivariate analysis, operative time and perioperative pathway (odds ratio for ERAS, 0.144; P < .001; odds ratio for ERAS and PreHab, 0.025; P < .001) were independently predictive for a prolonged length of stay (P < .001). Costs significantly decreased when ERAS and PreHab pathways were combined. CONCLUSIONS The implementation of ERAS and PreHab programs significantly changes the postoperative course of patients and may synergistically optimize RARP outcomes. The combination of these pathways improves patient recovery and is associated with reduced lengths of stay, blood loss, operative times, and costs without an increase in the postdischarge readmission rate.
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Affiliation(s)
| | - Christophe Almeras
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | | | | | - Valérie Garnault
- Department of Public Health, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | | | | | - Guillaume Loison
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | - Ambroise Salin
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | - Christophe Tollon
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France
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Exploring the Positive Thinking of Patients With Prostate Cancer: Self-efficacy as a Mediator. Cancer Nurs 2020; 45:E329-E337. [PMID: 32649333 DOI: 10.1097/ncc.0000000000000868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has explored the effectiveness of positive thinking on individuals, but only a few studies have investigated the factors that influence individual positive thinking, particularly among patients with prostate cancer. OBJECTIVES The aim of this study was to understand the factors that affect positive thinking among patients with prostate cancer and the mediating role of self-efficacy. METHODS A cross-sectional design and a convenience sampling method were used to recruit patients with prostate cancer from 2 hospitals in Taiwan. Structured scales were used for data collection, including the General Self-efficacy Scale, Expanded Prostate Cancer Index Composite, Positive Thinking Scale, and Social Support Scale. RESULTS The total average score for positive thinking among 201 patients was 66.1 (SD, 9.4). The factors that influenced the positive thinking of patients with prostate cancer included self-efficacy, treatment satisfaction, perceived health status, marital status, and appraisal support. The effects of treatment satisfaction and appraisal support on positive thinking were partly achieved through self-efficacy (partial mediation). CONCLUSIONS Self-efficacy is a mediator that affects the relationship of treatment satisfaction, appraisal support, and positive thinking. IMPLICATIONS FOR PRACTICE In the course of the disease, healthcare providers can help patients with prostate cancer to promote and maintain appropriate positive thinking by improving treatment satisfaction; increasing appraisal support from family, relatives, and friends; strengthening self-efficacy; and modifying unrealistic expectations.
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Mishra MV, Thayer WM, Janssen E, Hoppe B, Eggleston C, Bridges JFP. Patient preferences for reducing bowel adverse events following prostate radiotherapy. PLoS One 2020; 15:e0235616. [PMID: 32639983 PMCID: PMC7343167 DOI: 10.1371/journal.pone.0235616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Extended Prostate Cancer Index Composite (EPIC) instrument is a commonly used patient reported outcome (PRO) tool in prostate cancer clinical trials. Summary scores for EPIC subscales are calculated by averaging patient scores for attributes (e.g., side effects), implying equal weighting of the attributes in the absence of evidence showing otherwise. METHODS We estimated patient preferences for each of the attributes included in the bowel subscale of the EPIC instrument using best-worst (B-W) scaling among a cohort of men with prostate cancer. Patients were presented with multiple tasks in which they were asked to indicate which attribute they would find most and least bothersome at different levels of severity. Analysis utilized both (simple) B-W counts and scores to estimate patient preferences for each attribute as well as attribute levels. RESULTS A total of 174 respondents from two institutions participated in the survey. Preference estimates for each of the five attributes included in the EPIC-26 bowel subscale showed wide variation preferences: 'losing control of bowel movements' was found to be the most bothersome attribute, with a B-W score of -0.48, followed by bowel urgency which also had negative B-W score (-0.04). Increased frequency of bowel movements was the least bothersome attribute, with a B-W score of +0.33, followed by bloody stools (+0.12), and pelvic/rectal pain (+0.06). Analysis of preference weights for attribute bother levels showed preference estimates be linear. CONCLUSIONS We provide novel evidence on patient preferences for side effect reduction following prostate radiotherapy. Within the bowel sub-scale of the EPIC-26 short form, we found that bowel incontinence was perceived to be the most bothersome treatment effect, while increased bowel frequency was least bothersome to patients.
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Affiliation(s)
- Mark V. Mishra
- Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, MD, United States of America
- * E-mail:
| | - Winter Maxwell Thayer
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
| | - Ellen Janssen
- Center for Medical Technology Policy, Baltimore, MD, United States of America
| | - Bradford Hoppe
- Department of Radiation Oncology, Mayo Clinic-Florida, Tampa, FL, United States of America
| | - Caitlin Eggleston
- Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, MD, United States of America
| | - John F. P. Bridges
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States of America
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Doubova SV, Martinez-Vega IP, Gutiérrez-De-la-Barrera M, Infante-Castañeda C, Aranda-Flores CE, Monroy A, Gómez-Laguna L, Knaul FM, Pérez-Cuevas R. Psychometric validation of a Patient-Centred Quality of Cancer Care Questionnaire in Mexico. BMJ Open 2020; 10:e033114. [PMID: 32184306 PMCID: PMC7076235 DOI: 10.1136/bmjopen-2019-033114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To develop and validate a Patient-Centred Quality of Cancer Care Questionnaire in Spanish (PCQCCQ-S) appropriate to the Mexican context. DESIGN Psychometric validation of a questionnaire. SETTING Two public oncology hospitals in Mexico City. PARTICIPANTS 1809 patients with cancer aged ≥18 years. SOURCE OF INFORMATION Cross-sectional survey. METHODS The validation procedures comprised (1) content validity through a group of experts and patients; (2) item reduction and evaluation of the factor structure, through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach's alpha; (4) convergent validity between the PCQCCQ-S and supportive care needs scale; (5) correlation analysis between the PCQCCQ-S and quality of life scale by calculating Spearman's rank-correlation coefficient; and (6) differentiation by 'known groups' through the Wilcoxon rank-sum test. RESULTS The PCQCCQ-S has 30 items with the following five factors accounting for 96.5% of the total variance: (1) timely care; (2) clarity of the information; (3) information for treatment decision-making; (4) activities to address biopsychosocial needs; and (5) respectful and coordinated care. Cronbach's alpha values ranged from 0.73 to 0.90 among the factors. PCQCCQ-S has moderate convergent validity with supportive care needs scale, revealing that higher quality is correlated with lower patient needs. PCQCCQ-S has acceptable ability to differentiate by 'known groups', showing that older patients and those with low levels of education perceived lower total quality of care as compared with their counterparts. CONCLUSION PCQCCQ-S has acceptable psychometric properties and can be used to measure quality of patient-centred cancer care in Mexico and serve as a reference to develop PCQCCQ-S in other Spanish-speaking countries.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Ingrid Patricia Martinez-Vega
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | | | | | - Carlos E Aranda-Flores
- Servicio de Oncología, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
| | - Adriana Monroy
- Servicio de Oncología, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
| | - Laura Gómez-Laguna
- Servicio de Oncología, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
| | - Felicia Marie Knaul
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Kingston, Jamaica
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Richardson DR, Crossnohere NL, Seo J, Estey E, O'Donoghue B, Smith BD, Bridges JFP. Age at Diagnosis and Patient Preferences for Treatment Outcomes in AML: A Discrete Choice Experiment to Explore Meaningful Benefits. Cancer Epidemiol Biomarkers Prev 2020; 29:942-948. [PMID: 32132149 DOI: 10.1158/1055-9965.epi-19-1277] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/17/2019] [Accepted: 02/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The recent expansion of treatment options in acute myeloid leukemia (AML) has necessitated a greater understanding of patient preferences for treatment benefits, about which little is known. METHODS We sought to quantify and assess heterogeneity of the preferences of AML patients for treatment outcomes. An AML-specific discrete choice experiment (DCE) was developed involving multiple stakeholders. Attributes included in the DCE were event-free survival (EFS), complete remission (CR), time in the hospital, short-term side effects, and long-term side effects. Continuously coded conditional, stratified, and latent-class logistic regressions were used to model preferences of 294 patients with AML. RESULTS Most patients were white (89.4%) and in remission (95.0%). A 10% improvement in the chance of CR was the most meaningful offered benefit (P < 0.001). Patients were willing to trade up to 22 months of EFS or endure 8.7 months in the hospital or a two-step increase in long-term side effects to gain a 10% increase in chance of CR. Patients diagnosed at 60 years or older (21.6%) more strongly preferred to avoid short-term side effects (P = 0.03). Latent class analysis showed significant differences of preferences across gender and insurance status. CONCLUSIONS In this national sample of mostly AML survivors, patients preferred treatments that maximized chance at remission; however, significant preference heterogeneity for outcomes was identified. Age and gender may affect patients' preferences. IMPACT Survivor preferences for outcomes can inform patient-focused drug development and shared decision-making. Further studies are necessary to investigate the use of DCEs to guide treatment for individual patients.
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Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaein Seo
- Patient-Centered Research, Evidera, Rockville, Maryland
| | - Elihu Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - B Douglas Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Antonelli A, Palumbo C, Noale M, Artibani W, Bassi P, Bertoni F, Bracarda S, Bruni A, Corvò R, Gacci M, Magrini SM, Montironi R, Porreca A, Tubaro A, Zagonel V, Maggi S. Overview of potential determinants of radical prostatectomy versus radiation therapy in management of clinically localized prostate cancer: results from an Italian, prospective, observational study (the Pros-IT CNR study). MINERVA UROL NEFROL 2020; 72:595-604. [PMID: 31920063 DOI: 10.23736/s0393-2249.19.03637-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We assessed patients and tumor characteristics, as well as health-related quality of life (HRQoL) items, associated with curative intent treatment decision-making in clinically localized prostate cancer (PCa) patients. METHODS Clinically localized PCa treated with either radical prostatectomy (RP) or radiation therapy (RT) within 12 months from diagnosis were abstracted from The PROState cancer monitoring in ITaly, from the National Research Council (Pros-IT CNR) database. Multivariable logistic regression (MLR) models predicting RT vs. RP were fitted, after adjustment for HRQoL items, patients and tumor characteristics. RESULTS Of 1041 patients, 631 (60.2%) were treated with RP and 410 (39.8%) with RT. Relative to RT, RP patients were younger age (mean age 64.5±6.6 vs. 71.4±4.9, P<0.001) and had higher rates of D'Amico low-intermediate risk groups (31.8 vs. 21.9% low, 46.3% vs. 43.5% intermediate and 21.9% vs. 34.6% high risk, P<0.001). Overall, 93.2% of RP patients were enrolled by urologists and 82.7% of RT patients by radiation oncologists. RP patients had generally higher means values of HRQoL items. In MLR models, higher RT rates were independently associated with more advanced age (odds ratio [OR] 6.14, P<0.001) and BMI≥30 kg/m<sup>2</sup> (OR 1.78, P<0.001). Conversely, lower rates of RT were independently associated with married (OR 0.55, P=0.01) and worker status (OR 0.52, P=0.004), enrollment in academic centers (OR 0.59, P=0.005) and higher physical composite score (OR 0.88, P=0.03) and baseline sexual function items (OR 0.92, P<0.001). CONCLUSIONS Most patients with clinically localized prostate cancer undergoing definitive treatment at Italian institutions receive RP instead of RT. Moreover, those who are younger, married, working, as well as those with better physical and sexual function are more likely to undergo surgery.
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Affiliation(s)
- Alessandro Antonelli
- Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy -
| | - Carlotta Palumbo
- Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Marianna Noale
- Aging Branch, Neuroscience Institute, Section of Padua, National Research Council of Italy, Padua, Italy
| | - Walter Artibani
- Unit of Urology, University Hospital of Verona, Verona, Italy
| | - Pierfrancesco Bassi
- Department of Urology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Filippo Bertoni
- Prostate Group of AIRO (Italian Association for Radiation Oncology), Milan, Italy
| | - Sergio Bracarda
- Department of Medical Oncology, USL Toscana Sud-Est, IRCCS Istituto Nazionale Tumori Foundation, Arezzo, Italy
| | - Alessio Bruni
- Unit of Radiotherapy, University Hospital of Modena, Modena, Italy
| | - Renzo Corvò
- Unit of Radiation Oncology, IRCCS San Martino University Hospital, Genoa, Italy
| | - Mauro Gacci
- Unit of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Stefano M Magrini
- Unit of Radiation Oncology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, United Hospitals, Marche Polytechnic University, Ancona, Italy
| | - Angelo Porreca
- Unit of Urology, Polyclinic of Abano Terme, Padua, Italy
| | - Andrea Tubaro
- Unit of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Stefania Maggi
- Aging Branch, Neuroscience Institute, Section of Padua, National Research Council of Italy, Padua, Italy
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Jayadevappa R, Chhatre S, Gallo JJ, Wittink MN, Morales KH, Lee DI, Guzzo T, Vapiwala N, Wong YN, Newman DK, Van Arsdalen K, Malkowicz SB, Schwartz JS, Wein AJ. Reply to A. Vickers et al. J Clin Oncol 2019; 37:3463-3464. [DOI: 10.1200/jco.19.01450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ravishankar Jayadevappa
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Sumedha Chhatre
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Joseph J. Gallo
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Marsha N. Wittink
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Knashawn H. Morales
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - David I. Lee
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Thomas Guzzo
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Neha Vapiwala
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Yu-Ning Wong
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Diane K. Newman
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Keith Van Arsdalen
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - S. Bruce Malkowicz
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - J. Sanford Schwartz
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Alan J. Wein
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
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Vickers A, Carlsson SV. Toward Responsible, Informed Decision Making for Prostate Cancer Treatment Decisions. J Clin Oncol 2019; 37:3462. [PMID: 31566993 DOI: 10.1200/jco.19.00989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrew Vickers
- Andrew Vickers, PhD, Memorial Sloan Kettering Cancer Center, New York, NY; and Sigrid V. Carlsson, MPH, MD, PhD, Memorial Sloan Kettering Cancer Center, New York, NY, and Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sigrid V Carlsson
- Andrew Vickers, PhD, Memorial Sloan Kettering Cancer Center, New York, NY; and Sigrid V. Carlsson, MPH, MD, PhD, Memorial Sloan Kettering Cancer Center, New York, NY, and Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Jayadevappa R, Chhatre S, Gallo JJ, Malkowicz SB, Schwartz JS, Wittink MN. Patient-Centered Approach to Develop the Patient's Preferences for Prostate Cancer Care (PreProCare) Tool. MDM Policy Pract 2019; 4:2381468319855375. [PMID: 31259248 PMCID: PMC6589971 DOI: 10.1177/2381468319855375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/29/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives. To describe the development of our Patient Preferences for Prostate Cancer Care (PreProCare) tool to aid patient-centered treatment decision among localized prostate cancer patients. Methods. We incorporated patient and provider experiences to develop a patient preference elicitation tool using adaptive conjoint analysis. Our patient-centered approach used systematic literature review, semistructured patient interviews, and provider focus groups to determine the treatment attributes most important for decision making. The resulting computer-based PreProCare tool was pilot tested in a clinical setting. Results. A systematic review of 56 articles published between 1995 and 2015 yielded survival, cancer recurrence, side effects, and complications as attributes of treatment options. We conducted one-on-one interviews with 50 prostate cancer survivors and 5 focus groups of providers. Patients reported anxiety, depression, treatment specifics, and caregiver burden as important for decision making. Providers identified clinical characteristics as important attribute. Input from stakeholders' advisory group, physicians, and researchers helped finalize 15 attributes for our PreProCare preference assessment tool. Conclusion. The PreProCare tool was developed using a patient-centered approach and may be a feasible and acceptable preference clarification intervention for localized prostate cancer patients. The PreProCare tool may translate into higher participant engagement and self-efficacy, consistent with patients' personal values.
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Affiliation(s)
- Ravishankar Jayadevappa
- Department of Medicine, Perelman School of Medicine
- Division of Urology, Department of Surgery, Perelman School of Medicine
- Leonard Davis Institute of Health Economics
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | | | - Joseph J. Gallo
- General Internal Medicine, Johns Hopkins University School of Medicine, and Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - S. Bruce Malkowicz
- Division of Urology, Department of Surgery, Perelman School of Medicine
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - J. Sanford Schwartz
- Department of Medicine, Perelman School of Medicine
- Leonard Davis Institute of Health Economics
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marsha N. Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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