title: Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variation.
abstract: Men with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges of men's preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision aids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of two strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a) PtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use.
  
  
  
  Guided by the Knowledge to Action Framework, this comparative case study will be conducted using administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in Ontario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized prostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation oncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each setting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will be determined from administrative data. Factors associated with receiving the PtDA will be explored using multivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean and standard deviation (men's decisional conflict) and frequency and proportions (practitioners consulted, uptake of treatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will be calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression. Factors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic analysis of interview transcripts.
  
  
  
  Determining how to embed PtDAs effectively within clinical pathways for men with localized prostate cancer is essential. PtDAs have the potential to strengthen men's active role in making prostate cancer decisions, enhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers and knowledge users will use findings to improve current PtDA use and consider scaling-up implementation.
authors.affiliation: School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5, Canada. dstacey@uottawa.ca.|Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada. dstacey@uottawa.ca.
authors.forename: Dawn
authors.identifier: 0000-0002-2681-741X
authors.initials: D
authors.lastname: Stacey
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Smylie
authors.affiliation: Population Health, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Boland
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.|Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.|Department of Surgery, Division of Urology, University of Ottawa, 501 Smyth Rd, Ottawa, K1H 8L6, Canada.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
authors.forename: Meg
authors.initials: M
authors.lastname: Carley
authors.affiliation: Department of Surgery, Division of Urology, 537-750 Spadina Cr. E., Saskatoon, S7K 3H3, Canada.
authors.forename: Kunal
authors.initials: K
authors.lastname: Jana
authors.affiliation: Prostate Cancer Canada Network, Ottawa, Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Peckford
authors.affiliation: Quality and Continuous Improvement, Acute and Emergency Services Branch, Saskatchewan Ministry of Health, Regina, Canada.
authors.forename: Terry
authors.initials: T
authors.lastname: Blackmore
authors.affiliation: Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
authors.forename: Marian
authors.initials: M
authors.lastname: Waldie
authors.affiliation: Postgraduate Medical Education, University of Ottawa, Ottawa, Canada.
authors.forename: Robert Chi
authors.initials: RC
authors.lastname: Wu
authors.affiliation: Research Centre CHU de Quebec-Universite Laval, Quebec, Canada.
authors.forename: France
authors.initials: F
authors.lastname: Legare
mesh_terms: D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D009864:Ontario; D063868:Patient Outcome Assessment; D010358:Patient Participation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000628:therapy*
keywords: Comparative case studies; Implementation science; Patient decision aid; Prostate cancer; Study proposal