To evaluate the role of timing (either before or during initial consultation) on the effectiveness of DAs to support shared decision making (SDM) in a minority-enriched sample of patients with localized prostate cancer using a patient-level randomized controlled trial design.
We conducted a 3-arm, patient-level-randomized trial in urology and radiation oncology practices in Ohio, South Dakota, and Alaska, testing the effect of pre-consultation and within-consultation DAs on patient knowledge elements deemed essential to make treatment decisions about localized prostate cancer, all measured immediately following the initial urology consultation using a 12-item Prostate Cancer Treatment Questionnaire (score range 0 [no questions correct] to 1 [all questions correct]), compared to usual care (no DAs).
Between 2017 and 2018, 103 patients – including 16 Black/African American and 17 American Indian or Alaska Native men – were enrolled and randomly assigned to receive usual care (n=33) or usual care and a DA before (n=37) or during (n=33) the consultation. After adjusting for baseline characteristics, there were no statistically significant proportional score differences in patient knowledge between the pre-consultation DA arm (0.06 knowledge change, 95% CI -0.02-0.12, p=0.1) or the within-consultation DA arm (0.04 knowledge change, 95% CI -0.03-0.11, p=0.3) and usual care.
In this trial oversampling minority men with localized prostate cancer, DAs presented at different times relative to the specialist consultation showed no improvement in patient knowledge above usual care.

Copyright © 2023. Published by Elsevier Inc.