Decision Aid Use among Patients with Advanced Prostate Cancer

Randy A. Jones, PhD, RNPatricia Hollen, PhD, RN, FAAN

Richard Steeves, PhD, RN, FAANTerran Sims, MSN, RN, ACNP-BC

Christopher Thomas, MD

University of Virginia School of Nursing

Supported By

National Institutes of Health

National Cancer Institute

R21 grant sponsored by NIH/NCI - 1R21CA131754-01

University of Virginia Cancer Center Commonwealth Foundation Goodwin Trials Fund

Funding Sources

Background on the IssueProstate cancer is the most commonly diagnosed

cancer in men & is the second leading cause of cancer deaths among men in the U.S.

Almost all patients with advanced prostate cancer become refractory to hormone treatment.

When men develop castration resistant prostate cancer (CRPC), there are factors that affect therapeutic choice.

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Background on the Issue (cont.)CRPC has relatively a poor prognosis, thus

patients with CRPC, their support person, and healthcare provider are faced with complicated decisions.

Several decision aids for early stage prostate cancer treatment, but a gap remains – no decision aids available for advanced prostate cancer.

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Objectives of the StudyThe broad goal of this program of research is to

enhance patient care for prostate cancer by understanding the decision-making process in this population and to promote patient empowerment to make informed choices.

The major objective of this feasibility study is to explore testing a decision aid for patients with advanced prostate cancer to help facilitate informed, shared decisions about treatments that affect quality of life, including termination of cancer-directed treatment.

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Decision Aid ComponentsBalance sheet with pros and cons of the

decisions.

Clinics’ patient education material related to anticipatory guidance about the disease, treatment and quality of life.

CDs that contain information about how to make informed decisions, basic skills on how to communicate, find information, and stand up for your rights.

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Research DesignA pretest/ posttest design was used to measure

three decisions over the course of cancer directed treatment for individuals with CRPC.

Individual interviews were conducted to better explore the use of the decision aid within patients with CRPC and the decision making processAudiotapedInterview lasted no more than 1.5 hoursField notes taken

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SamplePatients were recruited from the University of

Virginia Cancer Center who met the study inclusion criteria:

1) a diagnosis of castration resistant prostate cancer 2) disease progression despite castration levels of

testosterone 3) life expectancy greater than 6 months 4) performance status of KPS 60-100% 5) age 18 years or older 6) a support person available to also participate 7) ability to understand English

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Findings – Demographics (Total)Characteristics Advanced Prostate Cancer

(N=22)

Patients Support Person

Age

Gender

Married

School Years Completed

Income (<$40,000)

70 (median)

100% men

82%

16 (median)0-22 (range)

45%

63 (median)

82% women

72%

15 (median)12-23 (range)

31%

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Data AnalysisDescriptive Statistics

Interviews analyzed using thematic analysisStrips identified, categories identified, and themes

formsRecurring themes examined using an iterative

approach until saturation

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Findings: ThemesTheme 1:

The Decision Aid Helped to Understand Treatment Decisions

Theme 2: The Decision Aid Helped the Patient/Support

Person to be More Involved in the Treatment Decisions

Theme 3: Frequent Contact with the Study Nurse was

Invaluable11

Theme 1: The Decision Aid Helped to Understand Treatment Decisions

Decision aid provided more insight into the progression of the disease and the treatment

Patients’ support persons said that the decision aid helped them to feel closer to the patient.

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Theme 2: The Decision Aid helped the patient/support person to be more involved in the treatment decisions

Decision making can be an overwhelming process and patients with cancer may not feel comfortable taking the initiative and/or playing an active role in the decision making with their healthcare provider.

Both patients and support persons thought that the decision aid helped them be more involved in their treatment.

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Theme 3: Frequent Contact with the Study Nurse was Valuable

Participants enjoyed having the study nurse contact them on a routine basis to follow up on their care, answer any questions they had about the study, and serve as an extra line of support.

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Implications

Findings from this study may assist healthcare providers to give better and more efficient healthcare in the short term

The study has the potential to assist in providing better quality of life among those diagnosed with CRPC

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Future Research

Develop and test a culturally-tailored intervention that includes Community Health Workers as cancer support resources

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Acknowledgements

Patients who participated in the studyDedicated research team

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Contact InformationRandy A. Jones, PhD, RN

Associate Professor, RWJF Nurse Faculty ScholarUniversity of Virginia School of Nursing

E-mail: [email protected]

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