Research Thesis Committee: Gladys Mokaya, RN, BScN, MScN (student), Denise Bryant-Lukosius, RN PhD CON(C), Carolyn Ingram, RN, DNSc, CON(C),

Margaret Black, RN, PhD, Ian Dayes, MD, MSc, FRCP(C), Dilip D. Panjwani, MD, MRCPI, FRCP(C)

GOAL AND RESEARCH QUESTIONS

Goal: To inform the development of a treatment decision aid for patients with locally recurrent

prostate cancer receiving care at two Ontario cancer centres; the Grand River

Regional Cancer Centre (GRRCC) and the Juravinski Cancer Centre (JCC).

Research questions:

1. To what extent is there consensus among radiation oncologists about the treatment

options to be included in a decision aid?

2. What are patient and radiation oncologist perceptions of the most important

treatment decisions for patients?

3. What are patient and radiation oncologist perceptions about the most difficult

treatment decisions for patients?

4. What are patient and radiation oncologist perceptions about barriers and facilitators

for patients in making treatment decisions?

5. What types of information do patients and radiation oncologists perceive as most

important to include in the treatment decision aid?

6. What are patient recommendations about how information should be provided to assist them in making treatment decisions?

BACKGROUND

POTENTIAL TREATMENT OPTIONS Analysis

METHODOLOGYDesign: A two-phase descriptive needs assessment study employing quantitative and qualitative methods.

Phase one

A Delphi process to establish physician consensus on treatment options to include in a treatment decision aid.

Sample:

All eight radiation oncologists providing care for men with locally recurrent prostate cancer at the GRRCC and JCC.

Data collection:

•A 15 to 30 minute individual interview to examine treatment options and decision-making challenges

•Qualitative interview data will inform the development of the next round of the Delphi process (survey)

•Electronic survey to obtain feedback and ratings on the importance of treatment options and information

•Last round of the electronic survey to summarize the results of the previous round and obtain physician

agreement and final ratings on the importance of treatment options and information.

Phase two:

Focus groups will be conducted to determine patient information and decision-making needs related to treatment

options identified in Phase one.

Sample:

Men who have received treatment for locally recurrent prostate cancer at the GRCC and the JCC within the last year.

Three to five focus groups involving 10 to 40 participants will be required to achieve data saturation.

Data Collection:

Focus groups will be conducted using a semi-structured interview guided adapted from the Population Needs

Assessment Guide (Jacobsen & O'Connor, 2006).

OUTCOMES

Thematic content analysis defined by Burnard (1991) will be used to analyze qualitative

data generated from the Delphi survey and focus groups. Two reviewers will

independently analyze the data to identify themes and concepts relevant to patient

information and treatment decision-making needs. Data from the Delphi process will be

analyzed to determine the strength of support for and importance of the selected

treatment options. This will include evaluating the degree of convergence on physician

opinions about the importance of treatment options and their perceptions of

challenging and important decisional needs relevant to these options.

N-Vivo software will be used to organize, manage and code the transcribed qualitative

data. Similarities and differences in identified themes will be compared to create a coding

scheme related to:

• the specific decisional needs for each of the identified treatment options

• what patients feel are the most important and difficult decisions

• barriers and facilitators to making decisions about treatment options

• strategies to address any challenges

• patient preferences about decision aid formats and methods of delivery

The themes will be summarized and similarities and differences in participant priorities for

a treatment decision aid will be identified. For focus groups, data collection and analysis

will be concurrent in order to inform decisions about continued data collection.

Descriptive statistics will be utilized to summarize data collected during the two rounds of

the electronic Delphi survey. Central tendencies will be used to summarize agreement

with survey statements and measures of dispersion will be computed to assess

consensus among the radiation oncologists

This study will provide three important outcomes:

1. Identification of radiation oncologists’ consensus on treatment options for patients

with locally recurrent prostate cancer

2. Improved understanding of patient perceptions about their information needs and

strategies to support treatment decision-making needs for locally recurrent prostate

cancer.

3. Research collaboration between the GRRCC and JCC to enhance the supportive

care of men with prostate cancer

Treatment and disease-related information is identified as an important but frequently unmet need for

men with prostate cancer. Strategies to improve information delivery and patient confidence in

treatment decision-making may contribute to long-term improvement in their overall psychosocial

well-being and quality of life.

Treatment decision-making for patients with locally recurrent prostate cancer is difficult because of

the number of available treatment options, differences in side effects and varied evidence about their

effectiveness. The complexity of the treatment choices indicates a need for patient access to an

information source that helps to explain the diagnosis and treatment of locally recurrent prostate

cancer. There is an absence of treatment decision-making aids or resources for this patient

population.

Decision aids aim to prepare users for treatment decision-making and provide detailed information on

treatment options and their outcomes. Decision aids have been found to improve patient involvement

and satisfaction with treatment decision-making and reduce the psychological stress associated with

making difficult decisions (Feldman-Stewart et al., 2004; O’Brien et al., 2009; O’Connor et al., 2007).

There are 7 steps to decision aid development. This study will focus on the first step: assessing the

need. The Population Needs Assessment Guide developed by Jacobsen and O’Connor (2006)

informed the development of this needs assessment.

Radiation Therapy (RT) +/-Adjuvant Hormone Therapy

Standard Therapy

(Standard of care)

Watchful Waiting (Observation)

Androgen Deprivation Therapy (ADT)

LHRH agonist (Medical castration)

Bilateral orchiectomy (surgical castration)

Experimental/Investigational Therapy (Guidelines)

Salvage Prostatectomy

Cryotherapy (Cryosurgery)

Re-irradiation or Brachytherapy

Clinical Trials (Options)

High Intensity Focused Ultrasound (HIFU)

Tookad Laser

REFERENCES1. Burnard, P. (1991). A method of analyzing interview transcripts in qualitative research. Nurse Education Today, 11,

461-466.

2. Feldman-Stewart, D., Brundage, M. D.., Van Manen L. & Svenson, O. (2004). Patient-focused decision-making in

early-stage prostate cancer: insights from a cognitively based decision aid. Health Expectations, 7, 126-141.

3. Jacobsen, M.J. & O’ Connor, A.M. (2006). Population needs assessment. A workbook for assessing patients’ and

practitioners’ decision making needs. Retrieved May 1, 2008 from: www.ohri.ca/decisionaid

4. O’Brien, M.A., Whelan, T.J., Villasis-Keever, M., Gafni, A., Charles, C., Roberts, R. Schiff, S. & Cai, W. (2009). Are

Cancer-Related Decision Aids Effective? A Systematic Review and Meta-Analysis. Journal of Clinical Oncology,

27, 6, 974-985.

5. O’Connor, A.M., Stacey, D., Entwistle, V., Llewellyn-Thomas, H., Rovner, D., Holmes-Rovner, M., Tait, V. Tetroe, J.

Fiset, V., Barry, M., & Jones, J. (2007). Decision aids for people facing health treatment or screening decisions

(Cochrane Review). The Cochrane Library, Issue 3.

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Funded by Grand River Hospital

Through: Motorcycle Ride For Dad