Treatment decision making in patients with prostatic disorders

Abstract

Shared decision making is applied in order to choose the best treatment option, adjusted to the patients’ individual preferences and values. Decision aids are instruments which can be used to support shared decision making in clinical practice. In this thesis, information satisfaction among prostate cancer survivors and the effect of decision aid use for the treatment of low- and intermediate risk prostate cancer and lower urinary tract symptoms due to bladder outlet obstruction (BOO) as a result of benign prostatic hyperplasia (LUTS/BPH) are studied. Results from this thesis demonstrated that: 1. on average four years after prostate cancer diagnosis, a third of patients indicated that they were dissatisfied with the information received at the time of diagnosis. 2. the decision aids for the treatment of low and intermediate risk prostate cancer and LUTS/BPH support undecided patients to indicate a treatment preference. Consequently, after decision aid use, the majority of the patients received their preferred treatment. 3. patients who used the prostate cancer decision aid chose active surveillance more often than patients who did not use the decision aid, indicating that the prostate cancer decision aid may affect treatment decision making in favour of the most conservative treatment option. Furthermore, after 12 months of follow up, no difference was found in information satisfaction and decisional regret between groups. In conclusion, this thesis showed that decision aids may support shared decision making in order to make preference-based treatment decisions in patients with prostate cancer and LUTS/BPH.