• David C Johnson, Dana E Mueller, Allison M Deal, Mary W Dunn, Angela B Smith, Michael E Woods, Eric M Wallen, Raj S Pruthi, and Matthew E Nielsen.
• Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: david.c.johnson1@gmail.com.
• J. Urol. 2016 Dec 1; 196 (6): 1640-1644.

PurposeMen with clinically localized prostate cancer face an archetypal "preference sensitive" treatment decision. A shared decision making process incorporating patient values and preferences is paramount. We evaluated the benefit of a novel decision making application, and investigated associations between patient preferences and treatment choice.Materials And MethodsWe used a novel, web based application that provides education, preference measurement and personalized decision analysis for patients with newly diagnosed prostate cancer. Preferences are measured using conjoint analysis. The application ranks treatment options according to their "fit" (expected value) based on clinical factors and personal preferences, and serves as the basis for shared decision making during the consultation. We administered the decisional conflict scale before and after completion of the application. Additionally, we compared post-visit perceptions of shared decision making between a baseline "usual care" cohort and a cohort seen after the application was integrated into clinical practice.ResultsA total of 109 men completed the application before their consultation, and had decisional conflict measured before and after use. Overall decisional conflict decreased by 37% (p <0.0001). Analysis of the decisional conflict subscales revealed statistically significant improvements in all 5 domains. Patients completing the decision making application (33) felt more included in (88% vs 57%, p=0.01) and jointly responsible for (94% vs 52%, p <0.0001) the decision about further treatment compared to those receiving usual care (24). More patients who completed the application strongly agreed that different treatment options were discussed (94% vs 74%, p=0.02).ConclusionsImplementation of this web based intervention was associated with decreased decisional conflict and enhanced elements of shared decision making.Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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