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A Patient Decision Aid for Men With Localized Prostate Cancer

A Comparative Case Study of Natural Implementation Approaches

Stacey, Dawn, RN, PhD; Taljaard, Monica, PhD; Breau, Rodney H., MSc, MD, FRCSC; Baba, Nicole, RN; Blackmore, Terry, BScPT; Boland, Laura, MSc, SLP-C, PhD(c); Carley, Meg, BSc; Wu, Robert Chi, MSc, MD, FRCSC; Smylie, Jennifer, RN, BN, MHSM; Légaré, France, MD, PhD

doi: 10.1097/NCC.0000000000000651
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Background There are multiple options for men diagnosed with localized prostate cancer. Patient decision aids (PtDAs) help empower individuals and reduce unwarranted practice variation, but few are used in clinical practice.

Objective We compared 2 programs implementing PtDAs for men with localized prostate cancer.

Methods This was a comparative case study. Case 1 was a hospital prostate pathway and case 2 was a provincial prostate pathway with 2 locations (2a, 2b). Nurses provided the men with PtDAs and answered questions. Data sources were as follows: (a) 2 years administrative data for men with localized prostate cancer, (b) clinicians survey and interviews, and (c) patients/spouses interviews. Analysis was within and across cases.

Results The PtDA was used with 23% of men in case 1 (95% confidence interval, 19.8%–26.1%) and 98% of men in case 2a (95% confidence interval, 96.5%–99.8%). The pathway was not implemented in case 2b. Men given the PtDA had positive experiences. Many clinicians supported the use of PtDAs, some adapted their discussions with patients, and others did not support the use of PtDAs. To increase use in case 1, participants identified needing a Canadian PtDA available electronically and endorsed by all clinicians. In case 2b, the provincial prostate pathway needed to be implemented.

Conclusions There was variable uptake of the PtDAs between the cases. Men who received the PtDA had positive outcomes. Several strategies were identified to increase or sustain PtDA use.

Implications for Practice Nurses have a key role in supporting men making decisions about prostate cancer treatment by providing PtDAs, answering questions, and advocating for men's preferences.

Author Affiliations: School of Nursing, University of Ottawa, Ontario, Canada (Dr Stacey); Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, Ontario, Canada (Drs Stacey, Taljaard, and Breau and Ms Carley); Department of Surgery, Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (Dr Breau); St. Paul's Hospital, Saskatoon, Saskatchewan, Canada (Ms Baba); Quality and Continuous Improvement, Acute and Emergency Services Branch, Saskatchewan Ministry of Health, Regina, Canada (Ms Blackmore); Population Health, Faculty of Health Sciences, University of Ottawa, Ontario, Canada (Ms Boland); Department of Surgery, Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis (Dr Wu); Ages Cancer Assessment Clinic, The Ottawa Hospital, Ottawa, Canada (Ms Smylie); and Research Center CHU de Québec-Université Laval, Hospital Saint-François D'Assise, Canada (Dr Légaré).

This study was funded by the Canadian Cancer Society Research Institute (grant 703678). Dr Stacey holds a Research Chair in Knowledge Translation to Patients, Ottawa University. Dr Légaré holds a Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University.

The authors have no conflicts of interest to disclose.

Authors' contributions: Dr Stacey drafted the study manuscript with Dr Taljaard, who conducted the statistical analysis. All authors reviewed and contributed to the draft manuscript and approved the final version.

Correspondence: Dawn Stacey, RN, PhD, School of Nursing University of Ottawa, Ottawa Hospital Research Institute, 451 Smyth Rd, Ottawa, Canada K1H 8 M5 (dstacey@uottawa.ca).

Accepted for publication June 27, 2018.

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