Background: Several treatment choices exist for advanced prostate cancer (APC), including hormone therapy, chemotherapy, immunotherapy, clinical trials, and stopping treatment.1,2 Engaging patients and their care partners in shared decision-making (SDM) discussions is not an easy task, especially if clinical trials are an option.3 Studies have shown that clinicians may need to make an extra effort to facilitate patient understanding of quantitative data from available clinical trials research to support SDM treatment conversations.3 This survey sub-analysis will discuss how provider-reported barriers to shared decision-making may impact clinical trial engagement for patients with APC.
Methods: A quantitative, multi-center study using two online internally validated surveys (one for healthcare providers, one for patients and their care partners) developed by expert prostate cancer professionals was conducted. The provider survey asked 37 questions rated on a Likert scale to elicit information about patient engagement in decision-making conversations from care team members who treat patients with APC. The patient/care partner survey had 32 questions rated on a Likert scale that asked participants about their assessment of treatment decision-making considerations and how providers engaged them in treatment decisions.
Results: There were 97 responses to the healthcare provider survey. Medical oncologists (n=37), radiation oncologists (n=21), and urologists (n=21) constituted 81% of the respondents. Other respondents were nurses, nurse navigators, advanced practice providers, social workers, and other non-clinical staff.
Ninety-four patients and their care partners responded to the survey (64% patients [n=60] and 36% care partners [n=34]). Forty-nine percent (n=46) of patients received multiple treatment modalities (as reported by patients and their care partners), but only 3% (n =3) reported that they had participated in clinical trials to treat their prostate cancer.
Eighty-five percent (n=82) of all provider respondents reported that they work directly with patients with APC to help them make care decisions and discuss with them clinical trial participation as a care option (always [6%], frequently [35%], sometimes [48%], and rarely [11%]). After discussing clinical trials with their patients, providers reported that patients enrolled in trials frequently (18%), sometimes (59%), rarely (22%), or never (1%). Providers indicated that the top barriers to engaging patients in treatment discussions were that patients were overwhelmed by the decisions to be made (51.5%), patients wanted the clinician to make the decision (40.2%), patients had limited health literacy (39.2%), and there was not enough time for a discussion (32%).
Conclusion: The patient/care partner survey indicated that clinical trials are not frequently used in treating patients with APC. The provider survey indicated that there are barriers to engaging patients in treatment decisions that may interfere with discussing clinical trials. Overcoming the barriers identified in these surveys may help increase the frequency of patient engagement with clinical trials as well as help patients feel comfortable considering trials as a treatment option. The current study suggests there is an opportunity for further research to explore ways to increase the frequency with which clinical trials are offered to all eligible patients during treatment decision-making discussions.
