Stacey Dawn, Taljaard Monica, Smylie Jennifer, Boland Laura, Breau Rodney H, Carley Meg, Jana Kunal, Peckford Larry, Blackmore Terry, Waldie Marian, Wu Robert Chi, Legare France
School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
Implement Sci. 2016 Jul 2;11(1):87. doi: 10.1186/s13012-016-0451-1.
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.
METHODS/DESIGN: 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.
患有局限性前列腺癌的男性往往抱有不切实际的期望。从业者很难判断男性的偏好，这导致了偏好误诊和不必要的医疗实践差异。患者决策辅助工具（PtDAs）可以帮助男性对局限性前列腺癌做出决策。这是一项比较案例研究，探讨在局限性前列腺癌男性患者的临床路径中实施PtDAs的两种策略，评估（a）PtDAs的使用情况；（b）对男性、从业者和卫生系统结果的影响；以及（c）影响持续使用的因素。
方法/设计：在知识转化为行动框架的指导下，本比较案例研究将使用行政数据、访谈和调查进行。案例将受地理位置（安大略省的一家医院；萨斯喀彻温省）和时间限制。符合条件的参与者将是所有新诊断为局限性前列腺癌的男性，使用行政数据和访谈评估结果。将对护士、泌尿科医生、放射肿瘤学家和管理人员进行调查，并对较小样本进行访谈。将为每个环境建立案例，并比较案例间的研究结果。通过行政数据确定两年内接受PtDAs的男性比例的变化。将使用多变量逻辑回归分析探索与接受PtDAs相关的因素。为了评估PtDAs的影响，将使用均值和标准差（男性的决策冲突）以及频率和比例（咨询的从业者、治疗的接受情况）来描述结果。为了估计PtDAs对这些结果的影响，将使用探索性多变量一般线性回归以及二元或多项逻辑回归计算调整后的均值差异和比值比。将通过对调查结果的描述性分析和访谈记录的主题分析来评估影响PtDAs持续使用的因素。
确定如何在局限性前列腺癌男性患者的临床路径中有效嵌入PtDAs至关重要。PtDAs有可能加强男性在前列腺癌决策中的积极作用，提高从业者对共同决策的接受度，并减少医疗实践差异。我们的研究人员和知识使用者团队将利用研究结果改进当前PtDAs的使用，并考虑扩大实施规模。
