Putting men's preferences at the centre of the patient-doctor relationship
2019-04-24

Prostate cancer is the most common cancer in men. There is no overall best treatment: each treatment has its own advantages and disadvantages. Treatments also affect each man differently, so the best treatment will depend on each person’s preferences.

A man diagnosed with prostate cancer will have a specialist nurse or doctor explain the treatment options and help him choose the right one for him. But this can be a difficult decision. Recently, we received a grant from The Urology Foundation to design a new and intuitive tool to make this decision easier for men.

The array of options and their consequences can be dizzying for patients

Over 3000 men are diagnosed with prostate cancer every year in Scotland and 1 in 8 men are expected to get prostate cancer in their lifetime. Men who are diagnosed with localised prostate cancer (cancer that is inside the prostate and hasn’t spread to other parts of the body) face a choice of different treatments:

  • active surveillance
  • prostatectomy
  • radiotherapy (external beam)
  • brachytherapy (internal radioactive implants)
  • ablative therapy (cryotherapy or high intensity focused ultrasound)

All treatments offer similar life expectancy, but they have different side effects:

  • erectile dysfunction
  • bowel problems
  • urinary incontinence
  • prostate cancer recurrence or need for more treatment

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The tool that will make this easier for men

Our tool, called a Decision Aid Tool, will explain the treatment options in a way the patient can understand and then presents patients with decision tasks that ask the patient to choose treatments. These tasks will help men figure out what matters most to them and make it easier for men to share their views with their health professionals.

This is a two-year research project, which will start in June 2019. This research is a collaboration between the Health Economics Research Unit and the Academic Urology Unit at the University of Aberdeen, and the Prostate Cancer group the Department of Surgery and Cancer at Imperial College London.

There are four stages planned for this research project:

Stage one: Use existing information to detect preference groups

We know that in life different things are important to different people. The same will be true for prostate cancer treatment. From previous research we carried out in HERU, we already know what is important to men with localised prostate cancer. We will re-examine this information to find groups of patients with similar views. This will help is understand the range of men’s views.

Stage two: Develop questions that predict which group a patient belongs to

If we know which group a patient belongs to, we can suggest the treatment that is most likely to match what is important to them. We will develop a set of questions to help us predict which group a patient is most likely to belong to. These questions form the core of our decision aid tool. We will test these questions by asking patients to answer these questions and tell us if they were useful.

Stage three: Design a tool that can be used in practice

Our tool will have three parts:

  1. Information about prostate cancer treatments based on other information tools such as the tool kit developed by Prostate Cancer UK.

  2. The set of questions from stage two.

  3. A report that includes information about the importance the patient places on the different treatment aspects, a prediction about the treatment that the patient is most likely to prefer. This prediction is based on the answers from stage two.

We want to be sure that we include the information that is most useful to patients, and to be sure the information is clear, we will ask patients to help us design the tool during this stage.

Stage four: Test the acceptability of the tool

Before making our tool widely available, we will test that urology health professionals find it useful. We will ask health professionals to use our tool with their patients and we will discuss the strengths and weakness of the tool with them.

We hope our tool will support patients with localised prostate cancer by helping them to decide which treatment is best for them and making it easier for patients to share their views with their healthcare professionals.

For more information about the project, please contact Dr Verity Watson and be sure to follow the HERU blog or our Twitter account.

 

HERU is supported by the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates (SGHSC). The views expressed here are those of the Unit and not necessarily those of the CSO.

Published by HERU, University of Aberdeen

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