title: The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: a multi-center randomized trial.
abstract: OBJECTIVE
  The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice.
  
  
  METHODS
  A randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored.
  
  
  RESULTS
  A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate -3.61; (confidence interval, -7.01, 0.22), and values clarity (estimate -3.57; confidence interval (-5.85,-1.30). Borderline effect was seen for the total decisional conflict score (estimate -1.75; confidence interval (-3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated.
  
  
  CONCLUSIONS
  The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences.
authors.affiliation: Dana-Farber Cancer Institute, Phyllis F. Cantor Center, Boston, MA 02215, USA. Electronic address: donna_berry@dfci.harvard.edu.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Berry
authors.forename: Barbara
authors.initials: B
authors.lastname: Halpenny
authors.forename: Fangxin
authors.initials: F
authors.lastname: Hong
authors.forename: Seth
authors.initials: S
authors.lastname: Wolpin
authors.forename: William B
authors.initials: WB
authors.lastname: Lober
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Russell
authors.forename: William J
authors.initials: WJ
authors.lastname: Ellis
authors.forename: Usha
authors.initials: U
authors.lastname: Govindarajulu
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Bosco
authors.forename: B Joyce
authors.initials: BJ
authors.lastname: Davison
authors.forename: Gerald
authors.initials: G
authors.lastname: Bennett
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.forename: Andrea
authors.initials: A
authors.lastname: Barsevick
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.forename: Claire C
authors.initials: CC
authors.lastname: Yang
authors.forename: Greg
authors.initials: G
authors.lastname: Swanson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy*