Development and Evaluation of the Personal Patient Profile-Bladder Cancer (P3-BC): A Web-Based Decision Support System for Patients Considering Cystectomy and Urinary Diversion.

Background/

Objectives

Radical cystectomy with urinary diversion is the standard treatment for patients with muscle-invasive bladder cancer, which represents a complex, preference-sensitive decision about the diversion options. To facilitate patient-clinician shared decision-making, we developed and evaluated the feasibility and acceptability of the Personal Patient Profile-Bladder Cancer (P3-BC), a web-based decision support system for patients considering urinary diversion options. Materials and

Methods

We employed an iterative development approach following an established framework, including qualitative assessments of radical cystectomy patients' (n = 30) needs to inform content development, followed by usability testing with 10 key stakeholders. We then conducted a feasibility study with patients newly diagnosed with bladder cancer undergoing cystectomy. Feasibility was assessed through P3-BC completion rates among patients randomized to the intervention and study retention rates. Acceptability was measured using a program-based 12-item questionnaire integrating the six-item Acceptability E-Scale. Secondary outcomes included decisional conflict, shared decision-making, psychological distress, and decisional regret.

Results

Of 114 eligible patients, 24 provided consent (21% consent rate), and 15 were randomized to receive the P3-BC intervention (n = 10) or usual care (n = 5). Retention was 93% at 1 month and 73% at 3 months. Among intervention participants, P3-BC achieved high feasibility (100% accessed the program) and acceptability, with 86% reporting overall satisfaction and 86% reporting ease of use. No statistically significant between-group differences were observed in secondary outcomes. Although the study was not powered to examine group differences, numerical trends suggest improvements in decisional conflict and symptom burden over time, particularly in the intervention group.

Conclusions

P3-BC demonstrated feasibility and acceptability as a web-based decision support intervention for patients with bladder cancer considering cystectomy and urinary diversion. Primary barriers to enrollment included treatment burden, limited diagnosis-treatment time, and technology concerns. Findings support progression to an adequately powered randomized controlled trial to evaluate clinical effectiveness.