An online decision aid for patients with prostate cancer evaluating local treatment options reduces decisional conflict and distress and improves knowledge: Postmarket surveillance in German routine care.

BACKGROUND AND

OBJECTIVE

Since 2016, more than 26,000 patients have used the online prostate cancer (PC) decision aid “Entscheidungshilfe Prostatakrebs”. Because a large, randomized, controlled evaluation trial failed to show effects regarding the primary and secondary outcomes after 4 weeks, we used postmarket surveillance data for further analyses. The aim of this study was to analyze the immediate effects of using a PC decision aid on decisional conflict, distress, and knowledge.

METHODS

A total of 2,245 patients used the PC decision aid between 05/2023 and 01/2024. We applied identical validated instruments before and after use to record immediate effects in an intra-individual comparison; the endpoints were decisional conflict (Decisional Conflict Scale, DCS), distress (Distress Thermometer), and objective knowledge (Decision Quality Worksheet).

RESULTS

Complete data were available for 880 patients (39.2%). The mean patient age was 66.3 ± 7.2 (range 43–84) years. The DCS score improved from 37.5 ± 23.7 before to 20.1 ± 15.7 after using the decision aid (p < 0.001). This effect was consistent across all the DCS subscales: level of information, clarity, support, and uncertainty. The Distress Thermometer (0: no distress; to 10: maximum distress) showed an improvement of 3.1 points from 6.2 ± 2.6 to 3.1 ± 2.6 (p < 0.001). Objective knowledge significantly improved for 4 out of the 5 questions, with differences in absolute percentages of correct answers ranging from 18.8% to 30%. The number of correct answers before vs. after using the PC decision aid increased from 2.3 ± 1.1 to 3.0 ± 1.1 (p < 0.001).

CONCLUSION

In conjunction with the results of our previous work, we can now report strong immediate effects that diminish over a period of four weeks: the evaluated online PC decision aid reduces decisional conflict and distress and improves patient knowledge. These results provide further support for offering this tool to all suitable patients. An ongoing randomized controlled study will address the current study limitations.