Professional Abstract

Objective

To test the effect of a tablet-based decision aid for patients with a recent diagnosis of prostate cancer and their caregivers compared with standard treatment information provided in booklets

Study Design

Design Elements	Description
Design	Randomized controlled trial
Population	179 patient/caregiver pairs where the patient had a recent diagnosis of prostate cancer
Interventions/ Comparators	PHIN™ on a mobile tablet delivered by a community navigator Standard information booklets on prostate cancer delivered by a community navigator
Outcomes	Prostate cancer knowledge, satisfaction with preparation for decision making, decisional satisfaction
Timeframe	12-month follow-up for study outcomes

Researchers conducted a randomized controlled trial to compare the Personalized Health Information Navigator (PHIN™), a newly developed decision-support application (app), with printed information about treatment options for prostate cancer from the National Cancer Institute. Delivered on an iPad®, the app provided patients and their caregivers with evidence-based, tailored information to help choose among treatment options for prostate cancer that are consistent with their personal preferences.

Both study arms used community navigators. Community navigators assisted in recruiting patients and caregivers, collected baseline data, and delivered either the tablet with the PHIN app or the printed information booklet. The navigators met with the men and their caregivers once a week for six weeks in person or by phone. In both arms, navigators helped the pairs go through the materials and answered questions about the information provided.

Patients in the study were men diagnosed with prostate cancer in the prior six months who had not yet started treatment. Of the men in the study, 87% were white, and the average age was 63. Caregivers included patients’ partners and spouses. Of the caregivers in the study, 97% were women, 84% were white, and the average age was 59.

Researchers randomly assigned 179 patient and caregiver pairs to receive either the mobile tablet with the app or standard information booklets. Patients and caregivers completed surveys at baseline, 6 weeks postintervention, and 6 and 12 months after baseline. Surveys asked about patient and caregiver knowledge of treatment options, satisfaction with preparation for decision making, and satisfaction with decisions.

A community health advocate and a prostate cancer survivor helped researchers develop the PHIN, review the paper booklet, and give input on recruitment strategies.

Results

Patients and caregivers who received the tablet app and those who received the printed materials did not differ in any study outcomes. In both groups, caregivers’ knowledge of prostate cancer increased from the start to the end of the study (p<0.01), and satisfaction with decisions improved over time for patients (p<0.05) and caregivers (p<0.01). Neither group experienced significant improvements in preparation for decision making.

Limitations

Attrition may have biased the results, as researchers were only able to contact 15% of randomized patients and caregivers at 12 months. Although the research team invited people from different races to join the study, most of the men who enrolled were white; results may be different for men of other races.

Conclusions and Relevance

Regardless of whether they used a computer-based app or a paper booklet, both patients and caregivers benefited from receiving information on prostate cancer treatment with the help of a community navigator. There were no differences in outcomes between the two randomized groups. However, the low follow-up response rate at 12 months makes this conclusion uncertain.

Future Research Needs

Future research could examine the effect of PHIN in a more diverse group of patients and caregivers. In addition, studies could aim to increase follow-up response rates for men and their caregivers.