This research project is in progress. PCORI will post its findings here within 90 days after our final review is complete. In the meantime, results have been published in peer-reviewed journals, as listed below.
Prostate cancer is a slow progressing and debilitating disorder that substantially limits the quality and quantity of life for millions of Americans. Due to uncertainties in outcomes, 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.
Objectives: To test the comparative effectiveness of a conjoint analysis intervention compared to usual care and identify preferred attributes of alternative prostate cancer treatments (including active surveillance) that will aid in designing ways to help patients weigh treatment attributes. We employ values markers, to represent clusters of values for particular aspects of treatments that are valued most by individual patients. We will test if the concordance between values markers and treatment received is predictive of objective outcomes (cancer recurrence and complications) and subjective outcomes (health-related quality of life, psychological well-being, satisfaction with decision, and satisfaction with care). Study hypothesis is that a conjoint task may have an effect on treatment choice, and prostate cancer patients whose treatment is more concordant with their values markers will have improved outcomes.
Study Design: We propose a two-phase study design. In Phase 1, to identify the attributes, we will conduct six focus groups of prostate cancer patients and two focus groups with physicians who treat prostate cancer. Next, we will develop a conjoint task instrument using the attributes identified in focus groups and pilot test it. This task requires the patients to trade off various treatments by assessing relative importance of particular treatment attributes. Results of Phase 1 will yield a conjoint analysis instrument to identify profiles of treatment values markers and will be used in Phase 2 to determine common values markers, or profiles of treatment attributes prostate cancer patients value most. Phase 2 consists of a stratified (UPHS, Fox Chase, and PVAMC) randomized controlled trial study of 720 men with localized prostate cancer, aged = 45 and randomized to either the conjoint task intervention group or usual care control group, and followed for up to 24 months for objective and subjective outcomes. We will analyze the effect of conjoint task intervention, association between preferences (developed using the values markers obtained at baseline, pretreatment), treatment, and objective and subjective outcomes. The conjoint task we develop and test here can lead to a values-based patient-centered decision aid and help tailor treatment decision making to the values of prostate cancer patients. This will ultimately improve clinical decision making, improve clinical policy process, enhance patient-centered care, and improve prostate cancer outcomes.