Project Summary

This implementation project is complete.

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is using results from a recent study comparing three treatments for localized prostate cancer to support patients in making informed decisions about their care.

Prostate cancer is one of the most common types of cancer in men. Localized prostate cancer has not spread beyond the prostate gland. Surgery or radiation may help men live longer. But these treatments have side effects, such as problems having sex or urinary or bowel problems. Men who have a low risk of their cancer spreading can also choose an active surveillance approach with regular check-ups instead of having treatment right away. Patients can work with their doctors to consider the benefits and harms of these treatments and make decision that works best for them.

What was the goal of this implementation project?

Shared decision making, or SDM, is a process in which patients and doctors work together to make healthcare decisions. A PCORI-funded study compared three common treatments for localized prostate cancer: surgery, radiation, and active surveillance. The study looked at the effects of these treatments on patients’ quality of life.

This project brought the results from this and other studies to men with localized prostate cancer and their doctors to help them choose a treatment.

What did this project do?

First, the project team updated a decision aid that was already in use at the University of California, Los Angeles, or UCLA, with the results from the study. Patients complete this decision aid before they meet with their doctors. The decision aid includes personalized information about prostate cancer and treatment options. It also asks patients about what is most important to them when it comes to treating their prostate cancer. After the patient completes the decision aid, they receive a summary report. The doctor also receives a report of the patient’s preferences to use during the patient visit.

Next, the project team put the decision aid into use at two other health systems in Tennessee and California. The sites differed in size and patient population as well as location.

Each site used a different approach to using the decision aid. For example, UCLA added the decision aid to its electronic health record system. At Olive View Medical Center, the other California site, patients filled out the decision aid in the waiting room.

To put the decision aid into use, the project team:

  • Worked with each site to make the decision aid part of regular care with minimal burden to doctors.
  • Trained health system leadership, doctors, and other staff about SDM and how to use the decision aid.
  • Identified champions who promoted the use of the decision aid.
  • Provided ongoing support and feedback reports to sites about use of the decision aid.
  • Translated the decision aid into Spanish.
  • Adapted the decision aid for use in telehealth during the COVID-19 pandemic. Telehealth is a way to provide care remotely using phone or video.

What was the impact of this project?

During the project, 1,961 men with newly diagnosed prostate cancer received the decision aid. The project team’s evaluation showed that:

  • Across the three sites, more than 80% of eligible patients received the decision aid and nearly 60% of these patients used it.
  • Patients reported low decisional conflict, high levels of shared decision making, and high satisfaction with cancer care.
  • At one site, the time patients spent with the doctor decreased from 33 minutes to 24 minutes (p=0.0096). Also, the percentage of patients who needed more than one visit to the urology clinic to make a treatment decision decreased.

Of note, at the smaller Olive View program, 85% of the patients who received the decision aid used it. Most of the nearly 50 patients who completed the decision aid in Spanish were patients at Olive View; at this center, 55% of patients are Latino and 40% are uninsured.

During the COVID-19 pandemic, use of the decision aid continued via telehealth.

All health systems plan to continue using the decision aid. The project team also developed a manual to help future sites use the decision aid.

Cost of Implementation:

This project team examined the costs associated with putting the SDM approach in place at each of the three sites.

The largest cost was for staff or clinician time spent identifying patients, sending the decision aid to patients, and reviewing the results. Sites also had to allocate space for shared decision making discussions.

For more details, view this project’s Cost of Implementation Report, which will be posted here when available.

PCORI supplemental funding supported project activities to capture and analyze the costs of implementation during this project. PCORI’s goal is to provide decision makers at future sites with information they can use when considering adoption of the intervention that was the focus of this PCORI-funded implementation project.

More about this implementation project:

Stakeholders Involved in This Project

  • California Prostate Cancer Coalition (CPCC)
  • National Alliance of State Prostate Cancer Coalitions (NASPCC)
  • Us TOO International
  • Institutional leadership at UCLA, Vanderbilt University Medical Center, and Olive View-UCLA Medical Center, which is part of the Los Angeles County Department of Health Services

Publicly Accessible Project Materials

  • Workflow templates
  • Decision aid Administrative Portal Tip Sheet
  • SPC chart table shells and use protocols
  • Patient invitation call scripts in English and Spanish
  • Patient-facing report templates in English and Spanish
  • Physician-facing report templates

For more information about these materials, please contact the Project Team at [email protected]

The project team developed these materials, which may be available for free or require a fee to access. Please note that the materials do not necessarily represent the views of PCORI and that PCORI cannot guarantee their accuracy or reliability.

    Project Achievements

    • Demonstrated the feasibility of using the decision aid in three health systems, with flexibility in implementation based on health system workflow and resources
    • Integrated the decision aid into the EPIC electronic health record system at UCLA
    • Created educational materials and an implementation manual to facilitate use of the decision aid
    • Translated decision aid into Spanish
    • Reached 1,961 men with newly diagnosed prostate cancer at the three health systems
    • Successfully adapted the decision aid to maximize its use during telehealth visits in response to the COVID-19 pandemic

    Implementation Strategies

    • Promoted shared decision making
    • Adapted the decision aid by including the results from the PCORI-funded CEASAR study and translating the decision aid into Spanish
    • Adapted the shared decision making approach, including plans for decision aid integration, to work with sites’ existing resources and workflows
    • Incorporated the decision aid into sites’ electronic health record systems
    • Provided educational materials to patients as part of decision aid
    • Trained clinicians and other health system staff on the benefits of shared decision making and on how to support the use of the decision aid
    • Provided tools to support implementation, such as protocols, scripts, and tip sheets
    • Provided sites with audit and feedback reports
    • Identified and prepared champions at sites
    • Provided technical assistance to sites, including ongoing consultation and practice facilitation
    • Developed an implementation manual that future sites can use to implement the decision aid

    Evaluation Measures 

    To document implementation:

    • Number of eligible men who received the decision aid
    • Number of eligible men who used the decision aid
    • Number of physicians trained and participating in the project
    • Fidelity of the SDM process

    To assess healthcare and health outcomes:

    • Patient-reported decisional conflict, patient satisfaction, and perception of SDM
    • Time spent with physician (Olive View only)
    • Number of patients who needed more than one visit to the urology clinic to make a decision about treatment (Olive View only)

    More to Explore...

    Media Mentions

    Study Lets Prostate Cancer Patients Give Input to Help Others Choose Best Treatment
    Conwill, The Tennessean, April 20, 2019
    In a guest opinion column, Ralph Conwill—a prostate cancer survivor and a patient partner on the related original research study—writes about his involvement in the research and notes that he served as "an equal partner...alongside the scientists in what is a truly patient-centered approach." Conwill adds that he is assisting in this project.

    Project Information

    Christopher Saigal, MD, MPH
    Regents of the University of California, Los Angeles
    $2,103,365
    Using PCORI Data to Drive Better Decisional Quality for Men with Localized Prostate Cancer

    Key Dates

    June 2018
    June 2022
    2018
    2022

    Study Registration Information

    Initial PCORI-Funded Research Study

    This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Comparing the Effects of Surgery, Radiation Therapy, and Active Surveillance on Men with Localized Prostate Cancer -– The CEASAR Study

    Tags

    Project Status
    Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
    State State The state where the project originates, or where the primary institution or organization is located. View Glossary
    Project Details Type
    Last updated: December 2, 2022