For men with newly-diagnosed, early-stage prostate cancer, a Web-based tool can reduce ambivalence about managing the disease by guiding them to choices that align with their personal priorities,
a large, multi-center clinical trial led by a Dana-Farber Cancer Institute investigator found.
The trial results, published by the Journal of Urology, reaffirm the ability of the Personal Patient Profile-Prostate (P3P) decision aid to reduce decisional conflict that men with prostate cancer commonly feel when weighing options for managing the disease
with their care team, researchers say. These findings are consistent with those from a 2011 trial that tested P3P in a less diverse population of patients.
"Men diagnosed with localized prostate cancer often have several alternatives – including active surveillance, surgical removal of the prostate gland, and radiation therapy delivered by an external beam or seeds implanted in the prostate – which have
a range of potential side effects," says study leader Donna Berry, PhD, RN, AOCN, FAAN, of Dana-Farber. "We designed P3P to guide men through the decision-making process by taking their
individual preferences and values into account and coaching the men to discuss these with their doctors."
The trial enrolled a diverse group of nearly 400 men, from four regions of the United States, who were recently diagnosed with prostate cancer. Half used P3P, along with standard educational materials and reputable websites to consider their options;
half had access to the educational materials and websites alone. A month after their diagnosis, 305 of the participants answered questionnaires about the status of their decision-making, their personal characteristics, concerns, and preferences.
An analysis of the responses showed that men who used P3P were substantially less conflicted about their treatment decision than were those in the other group. Participants who had more consultations with a physician also tended to feel less conflicted,
The conflict men felt about their decision was influenced by the risk level of their disease. Men with cancer at low risk of spreading – for which a variety of options is available – tended to feel more conflicted than those with high-risk cancer, where
treatment guidelines are more focused.
After the close of the clinical trial, the researchers made P3P available to any patient at four study sites who wished to use it. Each site developed its own approach to informing patients about P3P and encouraging them to access the program. The most
effective approach, researchers found, was one adopted by Beth Israel Deaconess Medical Center in Boston, MA, where urologists, when informing patients of their prostate cancer diagnosis, told them about P3P and provided a web link to it. Clinical
coordinators, who schedule appointments, followed up with patients a few days later to answer questions and remind them about P3P. The second-best approach had nurse navigators, rather than urologists, tell patients about P3P, Berry said. Sites that
included only pamphlets or fliers about P3P in patient-information packets had less success in promoting P3P use.
"We concluded that there needs to be a single clinical 'champion' to let patients known about P3P and how it can help them in reaching a decision," says Berry, who directs the Phyllis F. Cantor Center for Research in Nursing and Patient Care Services
at Dana-Farber. "It's also important that non-licensed clinical staff understand upfront the value of support in decision-making for this group of patients."
P3P is available to patients at the TrueNTH website. Currently, eight treatment centers nationwide are planning programs to inform patients about P3P.
Funding for the study was provided by the National Institutes of Health, National Institute for Nursing Research (grant R01NR009692 CTN: NCT01844999).
Co-authors of the paper are: Fangxin Hong, PhD; Traci M. Blonquist, MS; and Barbara Halpenny, MA, of Dana-Farber; Christopher P. Filson, MD, MS, of Emory University School of Medicine, Winship Cancer Institute, and Atlanta VA Medical Center; Viraj A.
Master, MD, PhD, of Emory University School of Medicine and Winship Cancer Institute; Martin G. Sanda, MD, of Emory University School of Medicine; Peter Chang, MD, MPH, of Beth Israel Deaconess Medical Center; Gary W. Chien MD, of Kaiser Permanente
Los Angeles Medical Center; Randy A. Jones, PhD, RN, FAAN, of University of Virginia School of Nursing; Tracey L. Krupski, MD, of University of Virginia School of Medicine; Seth Wolpin, MPH, PhD, RN, of University of Washington School of Nursing;
Leslie Wilson, PhD, of University of California, San Francisco; Julia H. Hayes, MD, of Dana-Farber Cancer Institute at St. Elizabeth's Medical Center; Quoc-Dien Trinh, MD, of Brigham and Women's Hospital; Mitchell Sokoloff, MD, of University of Massachusetts
Medical Center; and Prabhakara Somayaji, MD, a physician in private practice in Niagara Falls, N.Y.