Pilot study of a utilities-based treatment decision intervention for prostate cancer patients Journal Article

Authors: Knight, S. J.; Nathan, D. P.; Siston, A. K.; Kattan, M. W.; Elstein, A. S.; Collela, K. M.; Wolf, M. S.; Slimack, N. S.; Bennett, C. L.; Golub, R. M.
Article Title: Pilot study of a utilities-based treatment decision intervention for prostate cancer patients
Abstract: This pilot study evaluates a shared decision-making approach to individual decision making in localized prostate cancer care. The approach is based on a decision analytic model that incorporates patient utilities, ie, patient preferences among possible health states that might occur with prostate cancer treatments. Data on comorbidities, histologic grade of the biopsy, and age were obtained for 13 patients with newly diagnosed localized prostate cancer who received care in a Veterans Administration medical center. Using a standard gamble technique, interviewers obtained patient utilities for 5 distinct health states related to prostate cancer treatment. Utilities and patient clinical and pathologic characteristics were incorporated into the decision analytic model, and the derived quality-adjusted life expectancies were shared with the treating urologist before the first patient-physician discussion about treatment options. The results of the pilot study raised 2 major concerns. First, 4 patients had utility scores of 1.0 for all of the possible health states, and 7 patients had inconsistent utilities in which they rated both impotence and incontinence as a better health state than having just one of these problems. Second, the model recommended radiation therapy to individuals with a broad range of clinical characteristics, pathologic findings, and utility scores. Many of the patients who were recommended radiation therapy by the model received discordant recommendations from the treating urologist. Future refinements of both the utility assessment exercise and decision analytic model may be needed before the feasibility of the model in the clinical setting can be determined.
Keywords: clinical article; treatment outcome; aged; disease-free survival; middle aged; survival rate; patient selection; united states; cancer radiotherapy; neoplasm staging; cancer grading; sensitivity and specificity; medical decision making; markov chains; radiotherapy; morbidity; risk factors; cancer therapy; age; prostate cancer; gleason score; prostatic neoplasms; health care utilization; patient participation; health status; pilot study; pilot projects; probability; urine incontinence; prostatectomy; prostate biopsy; comorbidity; scoring system; radiation therapy; decision making; quality adjusted life year; model; impotence; quality-adjusted life years; decision support techniques; observation; incontinence; shared decision-making; humans; prognosis; human; male; article; physician intervention; quality-adjusted life expectancies; social factors; utilities assessment; decision analytic model
Journal Title: Clinical Prostate Cancer
Volume: 1
Issue: 2
ISSN: 1540-0352
Publisher: Elsevier Inc.  
Date Published: 2002-09-01
Start Page: 105
End Page: 114
Language: English
PUBMED: 15046701
PROVIDER: scopus
DOI: 10.3816/CGC.2002.n.012
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Michael W Kattan
    218 Kattan