Barbara Joyce Davison

Introduction: There is no conclusive evidence that the roboticassisted laparoscopic radical prostatectomy (RARP) is superior to conventional open radical prostatectomy (ORP) when it comes to recovery of urinary and sexual function, and that the former surgical option results in less decision regret.Methods: Patients scheduled for both surgical procedures were surveyed prior to surgery, and then again at 6 and 12 months following treatment using the sexual and urinary modules of the Expanded Prostate Cancer Index Composite (EPIC) measure. Decision regret was measured at 12 months. Propensity score regression adjustment was used to account for differences between treatment groups by summarizing all covariate information into a single probability and to simulate randomization.Results: At 12 months, urinary summary scores approached baseline levels, while urinary bother scores had returned to baseline. Sexual summary and bother mean scores decreased by about half of what they were at baseline for both treatment groups at 6 and 12 months. No significant differences in the groups’ sexual summary and bother domains were identified at either 6 or 12 months. Both groups’ scores for decision regret were low. Moderate correlations (r2 range -0.333 to -0.368) were between current levels of urinary and sexual function and decision regret at 12 months.Conclusion: The results of our study found no significant difference in health-related quality of life outcomes based on surgical procedure at 12 months. Moreover, patients in both groups reported low levels of decision regret at 12 months. Further multi-site prospective studies are required to address this study’s limitations.

Legal, ethical, and psychological arguments indicate that patients need to receive information about their health situations before their care decisions are made. Patient decision aids (PtDAs) are designed to help patients make decisions; therefore, they should provide information that results in patients understanding their health situation. We reviewed studies that assessed the impact of PtDAs on patient knowledge and on their feeling of being uninformed.

Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design.

Prostate cancer (PC) patients continue to have unmet information needs at the time of diagnosis and are often unable to communicate their preferences to physicians at the time of the treatment consultation. The objective of the study was to determine the impact of health information-seeking behavior (HISB) and personal factors on patients' preferred role in treatment decision making (TDM). Participants consisted of 150 men with newly diagnosed PC seen at 2 urology clinics in western Canada. A survey questionnaire was used to gather information on HISB, personal factors influencing treatment choice, and decision control. More than 90% of the participants reported a preference to play either an active or collaborative role in TDM and having either an "intense" or "complementary" HISB. No significant association was found between HISB and preferred role in TDM. Impact of treatment on survival and urinary function and the urologist's recommendation were identified as the 3 main factors influencing the treatment decision. At the time of diagnosis, the majority of men want to be involved in TDM and have access to information. Our findings suggest that the type and amount of information men want to access are dependent on HISB. Assessing factors having an impact on TDM may prove useful to guide patient-clinician treatment discussions. This survey provides clinicians with a method to assess information and decision preferences of men with newly diagnosed PC and factors having an influence on treatment choice.

Study Type – Therapy (patient's preference) Level of Evidence 2b What's known on the subject? and What does the study add? Erectile dysfunction after radical prostatectomy (RP) continues to cause men significant levels of distress, but few report being satisfied with the erectile aids that are prescribed. Most couples who do seek treatment report difficulty in maintaining sexual activity and intimate relationships. Although inclusion of partners in sexual rehabilitation programmes may be beneficial, partners are usually not included as part of current treatment protocols. Preoperative assessment of a couple's readiness to engage in a sexual rehabilitation programme is needed given that only 41% of patients scheduled for a radical prostatectomy during the study period agreed to be in the study. Results show that although patients have mild erectile function, their partners' overall levels of sexual function suggest a need for further medical evaluation. Patients want their partners to be included in the sexual rehabilitation process but few institutions currently offer couple‐based rehabilitation programmes. Although intimacy levels of couples are high preoperatively, there is a need to prospectively determine how these levels are impacted by changes in sexual function postoperatively. OBJECTIVES: To evaluate the readiness of couples to engage in a sexual rehabilitation programme (SRP) before radical prostatectomy (RP) and to identify barriers to participation in an SRP after RP. To identify couples' current levels of sexual function and intimacy. PATIENTS AND METHODS: Patients completed the International Index of Erectile Function (IIEF) and their partners completed the Female Sexual Function Index (FSFI) to measure sexual function. Couples completed the Miller Social Intimacy Scale (MSIS) to measure intimacy in relationships. All participants were seen by a sexual health clinician after completing the measures to discuss barriers to participation in an SRP, and to receive an education session. RESULTS: Study participants comprised 143 patients and 104 partners. Patients P < 0.002) compared with those patients aged 60 years and older. Partners' sexual function scores were suggestive of need for further medical evaluation. Partners' participation was cited by patients as important to them enrolling in an SRP. Couples' intimacy levels were strongly correlated ( P < 0.0001). CONCLUSIONS: Results suggest that less than 50% of patients are interested in receiving information about the impact of RP on sexual function before surgery. Female sexual function should be assessed as part of any SRP because they may require medical treatment if they are to support rehabilitation efforts for their spouses. Baseline assessment of a couple's sexual function and willingness to participate in an SRP should be performed preoperatively.

The Control Preferences Scale is widely used in decision research to measure patient preferences for participation in treatment decision making with health care providers. Following anecdotal reports of confusion with the scale the authors conducted an exploratory interview study to examine perceptions of the meaning and applicability of the Control Preferences Scale for men with localized prostate cancer seeking treatment in a multidisciplinary urology clinic. The preliminary data suggest potential validity challenges when the Control Preferences Scale is used in a multidisciplinary prostate cancer care setting, including the clinical context of localized prostate cancer and the meaning of shared decision making.

Study Type – Decision analysis (lacking sensitivity analysis) Level of Evidence 4 What’s known on the subject? and What does the study add? Active surveillance is a management strategy that offers patients the hope of avoiding the side effects associated with unnecessary treatment. This study identifies the resources required by men who choose to be on active surveillance to support them in their treatment decision. OBJECTIVES: To examine the decision‐making processes of men on active surveillance (AS). To identify the resources that men want to access to make, support and sustain them while on AS. PATIENTS AND METHODS: Three‐part survey developed for this study based on a qualitative study of 25 men on AS. Survey items explored: role men assumed with their physician in treatment decision‐making, factors influencing decision to go on AS, and resources required while on AS. Surveys mailed out to cross‐sectional sample of men on AS for less than 10 years. RESULTS: 27% of the 73 men reported assuming an active role in treatment decision‐making with their urologist, 41% a shared role and 32% a passive role. 82% of men reported being comfortable and 90% being satisfied with their decision to be on AS. 55% reported not being anxious about the cancer progressing while on AS. Urologist’s opinion, current age, and impact of treatment on urinary function were main factors influencing treatment decision. Information on future treatment options, non‐traditional treatments and diet considered most important resources. CONCLUSIONS: Results suggest that once men make a decision to go on AS, they are satisfied with their decision and few report being anxious about progression of cancer. Men are strongly influenced by the treating specialist in taking up AS. Additional information and psychological support resources are required for men on AS.