Improving Shared Decision Making for Men with Early-Stage Prostate Cancer

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.

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.

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)