title: A prospective cohort study of treatment decision-making for prostate cancer following participation in a multidisciplinary clinic.
abstract: BACKGROUND
  Patients diagnosed with prostate cancer (PCa) are presented with several treatment options of similar efficacy but varying side effects. Understanding how and why patients make their treatment decisions, as well as the effect of treatment choice on long-term outcomes, is critical to ensuring effective, patient-centered care. This study examined treatment decision-making in a racially diverse, equal-access, contemporary cohort of patients with PCa counseled on treatment options at a multidisciplinary clinic.
  
  
  METHODS
  A prospective cohort study was initiated at the Walter Reed National Military Medical Center (formerly Walter Reed Army Medical Center) in 2006. Newly diagnosed patients with PCa were enrolled before attending a multidisciplinary clinic. Patients completed surveys preclinic and postclinic to assess treatment preferences, reasons for treatment choice, and decisional regret.
  
  
  RESULTS
  As of January 2014, 925 patients with PCa enrolled in this study. Surgery (54%), external radiation (20%), and active surveillance (12%) were the most common primary treatments for patients with low- and intermediate-risk PCa, whereas patients with high-risk PCa chose surgery (34%) or external radiation with neoadjuvant hormones (57%). Treatment choice differed by age at diagnosis, race, comorbidity status, and calendar year in both univariable and multivariable analyses. Patients preferred to play an active role in the decision-making process and cited doctors at the clinic as the most helpful source of treatment-related information. Almost all patients reported satisfaction with their decision.
  
  
  CONCLUSIONS
  This is one of the first prospective cohort studies to examine treatment decision-making in an equal-access, multidisciplinary clinic setting. Studies of this cohort would aid in understanding and improving the PCa decision-making process.
authors.affiliation: Department of Defense, Center for Prostate Disease Research, Rockville, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Hurwitz
authors.affiliation: Department of Defense, Center for Prostate Disease Research, Rockville, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cullen
authors.affiliation: Department of Defense, Center for Prostate Disease Research, Rockville, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD; Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Sally
authors.initials: S
authors.lastname: Elsamanoudi
authors.affiliation: Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Jane
authors.initials: J
authors.lastname: Hudak
authors.affiliation: Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Maryellen
authors.initials: M
authors.lastname: Colston
authors.affiliation: Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Judith
authors.initials: J
authors.lastname: Travis
authors.affiliation: Department of Defense, Center for Prostate Disease Research, Rockville, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
authors.forename: Huai-Ching
authors.initials: HC
authors.lastname: Kuo
authors.affiliation: Department of Defense, Center for Prostate Disease Research, Rockville, MD; Department of Urology, Virginia Mason Medical Center, Seattle, WA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Porter
authors.affiliation: Department of Defense, Center for Prostate Disease Research, Rockville, MD; Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: inger.l.rosner.mil@mail.mil.
authors.forename: Inger L
authors.initials: IL
authors.lastname: Rosner
mesh_terms: D000368:Aged; D003657:Decision Making; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010348:Patient Care Team; D010358:Patient Participation; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: Decision-making; Multidisciplinary clinic; Patient preferences; Prostate cancer; Treatment