title: Integrating Patient Preference into Treatment Decisions for Men with Prostate Cancer at the Point of Care.
abstract: Men with clinically localized prostate cancer face an archetypal "preference sensitive" treatment decision. A shared decision making process incorporating patient values and preferences is paramount. We evaluated the benefit of a novel decision making application, and investigated associations between patient preferences and treatment choice.
  
  
  
  We used a novel, web based application that provides education, preference measurement and personalized decision analysis for patients with newly diagnosed prostate cancer. Preferences are measured using conjoint analysis. The application ranks treatment options according to their "fit" (expected value) based on clinical factors and personal preferences, and serves as the basis for shared decision making during the consultation. We administered the decisional conflict scale before and after completion of the application. Additionally, we compared post-visit perceptions of shared decision making between a baseline "usual care" cohort and a cohort seen after the application was integrated into clinical practice.
  
  
  
  A total of 109 men completed the application before their consultation, and had decisional conflict measured before and after use. Overall decisional conflict decreased by 37% (p <0.0001). Analysis of the decisional conflict subscales revealed statistically significant improvements in all 5 domains. Patients completing the decision making application (33) felt more included in (88% vs 57%, p=0.01) and jointly responsible for (94% vs 52%, p <0.0001) the decision about further treatment compared to those receiving usual care (24). More patients who completed the application strongly agreed that different treatment options were discussed (94% vs 74%, p=0.02).
  
  
  
  Implementation of this web based intervention was associated with decreased decisional conflict and enhanced elements of shared decision making.
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: david.c.johnson1@gmail.com.
authors.forename: David C
authors.initials: DC
authors.lastname: Johnson
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Dana E
authors.initials: DE
authors.lastname: Mueller
authors.affiliation: Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Mary W
authors.initials: MW
authors.lastname: Dunn
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Woods
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data*; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000628:therapy*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires
keywords: decision making; decision support techniques; patient preference; prostatic neoplasms