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Patient-Centered Preference Assessment to Improve Satisfaction With Care Among Patients With Localized Prostate Cancer: A Randomized Controlled Trial

  • Ravishankar Jayadevappa 1,
  • Sumedha Chhatre 1,
  • Joseph J. Gallo 3,
  • Marsha Wittink 4,
  • Knashawn H. Morales 1,
  • David I. Lee 1,
  • Thomas J. Guzzo 1,
  • Neha Vapiwala 1,
  • Yu-Ning Wong 5,
  • Diane K. Newman 1,
  • Keith Van Arsdalen 2,
  • S. Bruce Malkowicz 1,
  • J. Sanford Schwartz 1,
  • Alan J. Wein 1
1 University of Pennsylvania, Philadelphia, PA 2 Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA 3 Johns Hopkins University, Baltimore, MD 4 University of Rochester School of Medicine and Dentistry, Rochester, NY 5 Temple University, Philadelphia, PA

Publication: Journal of Clinical Oncology, April 2019

DOI: 10.1200/JCO.18.01091

https://ascopubs.org/doi/10.1200/JCO.18.01091

Purpose

To study the effectiveness of the Patient Preferences for Prostate Cancer Care (PreProCare) intervention in improving the primary outcome of satisfaction with care and secondary outcomes of satisfaction with decision, decision regret, and treatment choice among patients with localized prostate cancer.

Methods
In this multicenter randomized controlled study, we randomly assigned patients with localized prostate cancer to the PreProCare intervention or usual care. Outcomes were satisfaction with care, satisfaction with decision, decision regret, and treatment choice. Assessments were performed at baseline and at 3, 6, 12, and 24 months, and were analyzed using repeated measures. We compared treatment choice across intervention groups by prostate cancer risk categories.

Results
Between January 2014 and March 2015, 743 patients with localized prostate cancer were recruited and randomly assigned to receive PreProCare (n = 372) or usual care (n = 371). For the general satisfaction subscale, improvement at 24 months from baseline was significantly different between groups (P < .001). For the intervention group, mean scores at 24 months improved by 0.44 (SE, 0.06; P < .001) from baseline. This improvement was 0.5 standard deviation, which was clinically significant. The proportion reporting satisfaction with decision and no regret increased over time and was higher for the intervention group, compared with the usual care group at 24 months (P < .05). Among low-risk patients, a higher proportion of the intervention group was receiving active surveillance, compared with the usual care group (P < .001).

Conclusion
Our patient-centered PreProCare intervention improved satisfaction with care, satisfaction with decision, reduced regrets, and aligned treatment choice with risk category. The majority of our participants had a high income, with implications for generalizability. Additional studies can evaluate the effectiveness of PreProCare as a mechanism for improving clinical and patient-reported outcomes in different settings.