Decision Support Systems in Prostate Cancer Treatment: An Overview (original) (raw)
Related papers
A personalized decision aid for prostate cancer shared decision making
BMC Medical Informatics and Decision Making, 2021
Background A shared decision-making model is preferred for engaging prostate cancer patients in treatment decisions. However, the process of assessing an individual’s preferences and values is challenging and not formalized. The purpose of this study is to develop an automated decision aid for patient-centric treatment decision-making using decision analysis, preference thresholds and value elicitations to maximize the compatibility between a patient’s treatment expectations and outcome. Methods A template for patient-centric medical decision-making was constructed. The inputs included prostate cancer risk group, pre-treatment health state, treatment alternatives (primarily focused on radiation in this model), side effects (erectile dysfunction, urinary incontinence, nocturia and bowel incontinence), and treatment success (5-year freedom from biochemical failure). A linear additive value function was used to combine the values for each attribute (side effects, success and the altern...
Introduction Physicians spend more than half of their workday interacting with health information systems to care for their patients. Effective data management that provides physicians with comprehensive patient information from various information systems is required to ensure high quality clinical decision making.Objectives We evaluated the impact of a novel, CE-certified clinical decision support tool on physician’s effectiveness and satisfaction in the clinical decision-making process.Methods Using pre-therapeutic prostate cancer management cases, we compared physician’s expenditure of time, data quality, and user satisfaction in the decision-making process comparing the current standard with the software. Ten urologists from our department conducted the diagnostic work-up to the treatment decision for a total of 10 patients using both approaches.Results A significant reduction in the physician’s expenditure of time for the decision-making process by -59.9 % (p < 0,001) was f...
2019
The purpose of this research was to develop and pre-test an interactive decision-aid for men diagnosed with localized prostate cancer. A literature review of availability and effectiveness of empirically tested decision aids was done and then a prototype of the decision aid made. Semi-structured interviews with 12 men (65-80) diagnosed with localized prostate cancer were conducted to get feedback on ideas, content, usability and layout of the decision aid. Four of the participants had undergone active surveillance, four surgery/radiation therapy and four were newly diagnosed and had not yet undergone treatment. The interviews were transcribed verbatim and analyzed using content analysis. Participants valued the decision aid and found the accessibility of the information and the decision task helpful. Their points on improving the decision aid concerned the length of the text and flow. Also they wanted to make exercise and lifestyle recommendation a part of the decision aid as well a...
Supporting Informed Decision Making in Prevention of Prostate Cancer
ADCAIJ: ADVANCES IN DISTRIBUTED COMPUTING AND ARTIFICIAL INTELLIGENCE JOURNAL, 2015
Identifying and making the correct decision on the best health treatment or screening test option can become a difficult task. Therefore is important that the patients get all types of information appropriate to manage their health. Decision aids can be very useful when there is more than one reasonable option about a treatment or uncertain associated with screening tests. The decision aids tools help people to understand their clinical condition, through the description of the different options available. The purpose of this paper is to present the project “Supporting Informed Decision Making In Prevention of Prostate Cancer” (SIDEMP). This project is focused on the creation of a Web-based decision platform specifically directed to screening prostate cancer, that will support the patient in the process of making an informed decision
Decision Support with the Personal Patient Profile-Prostate: A Multi-Center Randomized Trial
The Journal of urology, 2017
The purpose was to evaluate the efficacy of the Web-based, Personal Patient Profile-Prostate decision aid versus usual care with regard to decisional conflict in men with localized prostate cancer. A randomized (1:1) controlled, parallel-group, nonblinded trial was conducted in four US regions. Eligible men had clinically localized prostate cancer, an upcoming consult, and spoke/read English or Spanish. Participants answered questionnaires to report decision-making stage, personal characteristics, concerns and preferences plus baseline symptoms and decisional conflict. A randomization algorithm allocated participants to receive tailored education and communication coaching, generic teaching sheets and external websites plus a one-page summary to clinicians (intervention), or the links plus materials provided in clinic (usual care). Conflict outcomes and number of consults were measured at 1-month. Univariate and multivariable models were used to analyze outcomes. 392 men were random...
Evaluating a Decision Aid for Patients with Localized Prostate Cancer in Clinical Practice
Urologia Internationalis, 2008
Aim: The aim of the study was to evaluate the usefulness of a decision aid regarding treatment options for patients with early-stage localized prostate cancer. Methods: 50 patients with newly diagnosed localized prostate cancer received the decision aid and were interviewed twice: before the decision-making consultation with the physicians and before treatment or, in case of watchful waiting, before the followup consultation. The physicians (radiation oncologists and urologists) were interviewed after the consultation. Results: The patients became more active partners in the decisionmaking process: They were better prepared for the consultation, asked more direct information, and were able to make a more deliberative choice. Generally, the use of the decision aid improved the quality of the consultation and resulted in a treatment decision agreed upon by both parties. Sometimes the consultation turned out to be more time-consuming. The decision aid did not only improve the patient-physician interaction but also helped patients to discuss the disease with their partner and family members. Conclusion: The use of the decision aid has a positive impact on the con-
Urologic Oncology-seminars and Original Investigations, 2013
The purpose of this trial was to compare usual patient education plus the Internetbased, Personal Patient Profile-Prostate, versus usual education alone, on conflict associated with decision making, plus explore time-to-treatment and treatment choice. METHODS-A randomized, multi-center clinical trial was conducted with measures at baseline, one and six months. Men with newly diagnosed localized prostate cancer who sought consultation at urology, radiation oncology or multidisciplinary clinics in four geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using Generalized Estimating Equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice and program acceptability/usefulness, were explored. RESULTS-A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time as compared with the control group, for the uncertainty score (estimate −3.61; (confidence interval, −7.01,−0.22) and values clarity (estimate −3.57; confidence interval (−5.85,−1.30) Borderline effect was seen for the total decisional conflict score (estimate −1.75; confidence interval (−3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated. CONCLUSION-The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized prostate cancer. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a prostate cancer treatment that is consistent with the patient values and preferences.
Health Informatics Journal
For the treatment choice of localized prostate cancer, effective patient decision aids have been developed. The implementation of decision aids in routine care, however, lags behind. Main known barriers are lack of confidence in the tool, lack of training on its use, lack of resources and lack of time. A new implementation strategy addresses these barriers. Using this implementation strategy, the implementation rate of a decision aid was measured in eight hospitals and questionnaires were filled out by 24 care providers and 255 patients. The average implementation rate was 60 per cent (range 31%–100%). Hardly any barriers remained for care providers. Patients who did not use the decision aid appeared to be more unwilling than unable to use the decision aid. By addressing known barriers, that is, informing care providers on the effectiveness of the decision aid, providing instructions on its use, embedding it in the existing workflow and making it available free of charge, a successf...
Trials, 2015
Background: At an early stage, prostate cancer patients are often eligible for more than one treatment option, or may choose to defer curative treatment. Without a pre-existing superior option, a patient has to weigh his personal preferences against the risks and benefits of each alternative to select the most appropriate treatment. Given this context, in prostate cancer treatment decision-making, it is particularly suitable to follow the principles of shared decision-making (SDM), especially with the support of specific instruments like decision aids (DAs). Although several alternatives are available, present tools are not sufficiently compatible with routine clinical practice. To overcome existing barriers and to stimulate structural implementation of DAs and SDM in clinical practice, a web-based prostate cancer treatment DA was developed to fit clinical workflow. Following the structure of an existing DA, Dutch content was developed, and values clarification methods (VCMs) were added. The aim of this study is to investigate the effect of this DA on (shared) treatment choice and patient-reported outcomes. Methods/design: Nineteen Dutch hospitals are included in a pragmatic, cluster randomized controlled trial, with an intervention and a control arm. In the intervention group, the DA will be offered after diagnosis, and a summary of the patients' preferences, which were identified with the DA, can be discussed by the patient and his clinician during later consultation. Patients in the control group will receive information and decisional support as usual. Results from both groups on decisional conflict, treatment choice and the experience with involvement in the decision-making process are compared. Patients are requested to fill in questionnaires after treatment decision-making but before treatment is started, and 6 and 12 months later. This will allow the development of treatment satisfaction, decisional regret, and quality of life to be monitored. Clinicians from both groups will evaluate their practice of information provision and decisional support.