Jayadevappa Ravishankar, Chhatre Sumedha, Gallo Joseph J, Wittink Marsha, Morales Knashawn H, Bruce Malkowicz S, Lee David, Guzzo Thomas, Caruso Adele, Van Arsdalen Keith, Wein Alan J, Sanford Schwartz J
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Division of Urology, Perelman School of Medicine, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, United States.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States.
Contemp Clin Trials. 2015 Nov;45(Pt B):296-301. doi: 10.1016/j.cct.2015.09.024. Epub 2015 Oct 3.
Prostate cancer is a slow progressing cancer that affects millions of men in the US. Due to uncertainties in outcomes and treatment complications, it is important that patients engage in informed decision making to choose the "optimal treatment". Patient centered care that encompasses informed decision-making can improve treatment choice and quality of care. Thus, assessing patient treatment preferences is critical for developing an effective decision support system. The objective of this patient-centered randomized clinical trial was to study the comparative effectiveness of a conjoint analysis intervention compared to usual care in improving subjective and objective outcomes in prostate cancer patients. We identified preferred attributes of alternative prostate cancer treatments that will aid in evaluating attributes of treatment options. In this two-phase study, in Phase 1 we used mixed methods to develop an adaptive conjoint task instrument. The conjoint task required the patients to trade-off attributes associated with treatments by assessing their relative importance. Phase 2 consisted of a randomized controlled trial of men with localized prostate cancer. We analyzed the effect of conjoint task intervention on the association between preferences, treatment and objective and subjective outcomes. Our conjoint task instrument can lead to a values-based patient-centered decision aid tool and help tailor treatment decision making to the values of prostate cancer patients. This will ultimately improve clinical decision making, clinical policy process, enhance patient centered care and improve prostate cancer outcomes.
前列腺癌是一种进展缓慢的癌症，影响着美国数百万男性。由于治疗结果和治疗并发症存在不确定性，患者进行明智的决策以选择“最佳治疗方案”非常重要。包含明智决策的以患者为中心的护理可以改善治疗选择和护理质量。因此，评估患者的治疗偏好对于开发有效的决策支持系统至关重要。这项以患者为中心的随机临床试验的目的是研究联合分析干预与常规护理相比，在改善前列腺癌患者主观和客观结果方面的比较效果。我们确定了替代前列腺癌治疗方法的首选属性，这将有助于评估治疗方案的属性。在这项两阶段研究中，在第一阶段，我们使用混合方法开发了一种自适应联合任务工具。联合任务要求患者通过评估其相对重要性来权衡与治疗相关的属性。第二阶段包括对局限性前列腺癌男性患者的随机对照试验。我们分析了联合任务干预对偏好、治疗与客观和主观结果之间关联的影响。我们的联合任务工具可以导致一个基于价值观的以患者为中心的决策辅助工具，并有助于根据前列腺癌患者的价值观调整治疗决策。这最终将改善临床决策、临床政策制定过程，加强以患者为中心的护理并改善前列腺癌的治疗结果。
