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Head to head randomized trial of two decision aids for prostate cancer

  • Fagerlin, Angela1, 2
  • Holmes-Rovner, Margaret3
  • Hofer, Timothy P.4, 5
  • Rovner, David3
  • Alexander, Stewart C.6
  • Knight, Sara J.1, 7
  • Ling, Bruce S.8
  • A.Tulsky, James9, 10
  • Wei, John T.5
  • Hafez, Khaled5
  • Kahn, Valerie C.11
  • Connochie, Daniel4
  • Gingrich, Jeffery12
  • Ubel, Peter A.12, 13
  • 1 Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA , Salt Lake City (United States)
  • 2 University of Utah, 295 Chipeta Way Rm 1S105, Salt Lake City, UT, 84132, USA , Salt Lake City (United States)
  • 3 Michigan State University, East Lansing, MI, USA , East Lansing (United States)
  • 4 Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA , Ann Arbor (United States)
  • 5 University of Michigan, Ann Arbor, MI, USA , Ann Arbor (United States)
  • 6 Purdue University, West Lafayette, IN, USA , West Lafayette (United States)
  • 7 University of Utah, Salt Lake City, UT, USA , Salt Lake City (United States)
  • 8 University of Pittsburgh, Pittsburgh, PA, USA , Pittsburgh (United States)
  • 9 Dana-Farber Cancer Institute, Boston, MA, USA , Boston (United States)
  • 10 Brigham and Women’s Hospital, Boston, MA, USA , Boston (United States)
  • 11 University of Michigan, Ann Arbor, USA , Ann Arbor (United States)
  • 12 Duke University, Durham, NC, USA , Durham (United States)
  • 13 Duke University, Durham, USA , Durham (United States)
Published Article
BMC Medical Informatics and Decision Making
Springer (Biomed Central Ltd.)
Publication Date
May 12, 2021
DOI: 10.1186/s12911-021-01505-x
Springer Nature


BackgroundWhile many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DAs affect key outcomes such as treatment choice, patient–provider communication, or decision process/satisfaction. This study tested the impact of a complex medical oriented DA compared to a more simplistic decision aid designed to encourage shared decision making in men with clinically localized prostate cancer.Methods1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy. Participants completed baseline measures and were randomized to receive either a simple or complex DA. Participants were men with clinically localized cancer (N = 285) by biopsy and who completed a baseline survey. Survey measures: baseline (biopsy); immediately prior to seeing the physician for biopsy results (pre- encounter); one week following the physician visit (post-encounter). Outcome measures included treatment preference and treatment received, knowledge, preference for shared decision making, decision making process, and patients’ use and satisfaction with the DA.ResultsParticipants who received the simple DA had greater interest in shared decision making after reading the DA (p = 0.03), found the DA more helpful (p’s < 0.01) and were more likely to be considering watchful waiting (p = 0.03) compared to those receiving the complex DA at Time 2. While these differences were present before patients saw their urologists, there was no difference between groups in the treatment patients received.ConclusionsThe simple DA led to increased desire for shared decision making and for less aggressive treatment. However, these differences disappeared following the physician visit, which appeared to change patients’ treatment preferences.Trial registration This trial was pre-registered prior to recruitment of participants.

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