Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia.
Cancer. 2021 Jan 15;127(2):203-208. doi: 10.1002/cncr.33241. Epub 2020 Oct 29.
Decision support tools improve decisional conflict and elicit patient preferences related to prostate cancer treatment. It was hypothesized that men using the Personal Patient Profile-Prostate (P3P) would be more likely to pursue guideline-concordant treatment.
Men from a trial assessing the P3P decision support intervention were identified. The primary exposure was allocation to P3P (vs usual care), and the outcome was appropriate treatment per guidelines (eg, low risk = active surveillance). It was assessed whether providers recommended against any treatment options (ie, restricted). A multivariable model was fit for men with low-risk cancer that estimated the odds of the outcome of interest.
This study identified 295 men in the cohort: 113 (38%) had low-risk disease, 119 (40%) had favorable intermediate-risk disease, and 63 (21%) had unfavorable intermediate-risk disease. Among low-risk patients, more men pursued active surveillance after using P3P whether they were given unrestricted (62% vs 54% with usual care; P = .54) or restricted options (71% vs 59% with usual care; P = .34). After adjustments, only Black race (odds ratio [OR], 0.31; 95% CI, 0.11-0.89) and restricted options (OR, 0.23; 95% CI, 0.08-0.65) had an inverse association with the receipt of surveillance for patients with low-risk prostate cancer. An impact associated with P3P versus usual care (OR, 0.89; 95% CI, 0.36-2.20) was not observed.
Among men in a trial assessing a decision support tool, Black race and restricted treatment options were associated with less use of active surveillance for low-risk prostate cancer. Although the P3P instrument ameliorates decisional conflict, its use was not associated with more appropriate alignment of treatment with disease risk.
决策支持工具可改善决策冲突并引出与前列腺癌治疗相关的患者偏好。据推测，使用个人患者档案-前列腺（P3P）的男性更有可能采用符合指南的治疗方法。
从评估 P3P 决策支持干预的试验中确定男性患者。主要暴露因素为 P3P 分配（与常规护理相比），结果为符合指南的适当治疗（例如，低危=主动监测）。评估提供者是否建议排除任何治疗选择（即限制）。为患有低危癌症的男性建立多变量模型，以估计感兴趣结果的可能性。
本研究在队列中确定了 295 名男性：113 名（38%）患有低危疾病，119 名（40%）患有有利的中危疾病，63 名（21%）患有不利的中危疾病。在低危患者中，使用 P3P 后更多男性选择了主动监测，无论他们是否获得了不受限制的治疗方案（与常规护理相比，分别为 62%和 54%；P=0.54）或限制的治疗方案（与常规护理相比，分别为 71%和 59%；P=0.34）。调整后，只有黑种人（比值比[OR]，0.31；95%置信区间，0.11-0.89）和限制的治疗方案（OR，0.23；95%置信区间，0.08-0.65）与接受低危前列腺癌监测呈负相关。与常规护理相比，P3P 的影响（OR，0.89；95%置信区间，0.36-2.20）不明显。
在评估决策支持工具的试验中，黑种人种族和限制的治疗方案与低危前列腺癌的主动监测使用率较低有关。尽管 P3P 工具可改善决策冲突，但它的使用与治疗与疾病风险的更适当匹配无关。
