Page 127 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Urban vs. rural. No study or survey specifically addressed how urban versus rural residence
might affect adherence to AS.

Academic Centers Versus Private Practice

Offer of AS. No study or survey specifically addressed whether the treatment facility’s status as
an academic centers versus a private practice might affect the offer of AS.

Acceptance of AS. One multivariable analysis reported that treatment facility status (academic
versus community practice) was not a significant factor in predicting receiving AS/WW versus
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active treatment.

Adherence to AS. No study or survey specifically addressed whether the treatment facility’s
status as an academic center versus a private practice might affect adherence to AS.

Communication Strategies

Risk Assessment, Predictive Models
No study or survey that specifically addressed the role of risk assessment and predictive
models in affecting the offer of, acceptance of, or adherence to AS. One study (a 2008 review 201 )
did, however, catalogue 109 prostate cancer predictive tools, which included endpoints like
disease recurrence, metastasis, and survival, though no studies were identified that systematically
assessed how these predictive tools were used in patient discussions.

Decision-making Tools and Aids
No study or survey specifically addressed how the use of decision-making tools or aids might
affect the offer or acceptance of, or adherence to, AS.
One 2009 systematic review did, however, report on the use of various decision aids (DAs)
to help men with low-risk prostate cancer participate actively in the decisionmaking process
concerning their treatments. 197 Thirteen of 219 articles (representing 3 RCTs and 10
nonrandomized trials) were judged eligible for inclusion. Eligibility criteria consisted of a study
population that included men with low-risk prostate cancer who had the option of RP, RT, or
WW. Using the Jadad scoring system, 202 the reviewers rated two RCTs as good 203,204 and one
poor. 205
The majority of the DAs examined were developed de novo. They included, either alone or in
combination, a written information package, consultation with a nurse or urologist, generic
video, interactive computer program/CD-ROM decision aid, and a personalized multidisciplinary
consultation. Most of the DAs were designed to be completed outside the clinic and after
diagnosis, but prior to making a decision.
The participants in general found the DAs to be informative. One RCT reported a decrease in
anxiety in participants in the intervention arm (written information package with discussion, a
list of questions they could ask their physician, and an audiotape of the medical consultation)
versus written information alone. 205 One RCT found that there was no difference in satisfaction
with treatment choice between those who received individualized DAs and those using a generic
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DA. One RCT found that the men in the DA arm selected their physician’s treatment choice
less often than those who received usual care. 203 The nonrandomized studies reported that DAs

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