New Tool Helps Patients With Prostate Cancer Decide if Watchful Waiting is Right

A new online tool can help patients with prostate cancer determine if active surveillance is the right decision.

More than 90 percent of prostate cancers are detected at a curable stage. Those patients with localized, low-risk prostate cancer are presented with two options upon diagnosis: active surveillance, in which doctors check the cancer periodically to see if there are any changes, or active treatment, which involves surgery and radiation. Doctors cannot foresee who is at risk for developing aggressive disease and may benefit from active treatment. Due to the uncertainty, most men choose active treatment over surveillance.

To help lessen the weight of the treatment decision on patients, researchers at Thomas Jefferson University created an online decision-support tool called the Decision Counseling Program.

In the study, which was published in the Journal of Cancer Education, the tool was offered to 30 patients with localized, low-risk prostate cancer. It provided patients with ample information regarding their disease, their treatment options and helped patients make a decision with their doctor.

Previous decision aids have been educational handouts, booklets or videos used to deliver information to patients. While these aids helped increase the amount of men choosing active surveillance, there were often conflicting results.

The Decision Counseling Program, however, fared much better with 83 percent of patients (25 of 30) with prostate cancer choosing active surveillance rather than active treatment, a rate much higher than what is typical.

“The Decision Counseling Program is used by a trained nurse educator to help patients understand their options, figure out what things would make them favor one option over the other and clarify the option they prefer,” said Ronald Myers, in a statement. Myers is a professor of Medical Oncology and researcher at the Sidney Kimmel Cancer Center at Jefferson and was the first author on the study. “The Decision Counseling Program also produces a one-page summary that the patient and his physician can use to make a shared decision that makes the most sense.”

After using the program, according to a press release, “patients had a higher level of knowledge about their treatment options, reported feeling less conflicted about the treatment decision, and had more favorable perceptions of active surveillance than they did at the outset of the study.”

Not only does this new system have a nurse educator using the program to provide information about options, but the nurse also identifies and weighs the importance of things that matter to the patients, such as worries about treatment side effects or concerns about developing aggressive cancer.

The Decision Counseling Program gives patients time to consider their options and discuss their thoughts and concerns with a physician. In turn, this provides patients with more of a voice in the entire process.

Although the Decision Counseling Program was implemented for prostate cancer treatment decision making for this study, the system can be applied to other areas of medicine in which “options are available, decisions are difficult, and the stakes of decision making are high,” the press release reads. This work has already begun, according to Myers.