What is the Role of Decision Support Software in the Decision Making Process for Men with Early Stage Prostate Cancer? A Mixed-Methods Approach to Understanding Personal Characteristics that Influence Use and the Decision Making Process

Purpose

Specific aim 1: To describe patterns of use of a computer assisted patient decision aid (CAPtDA) among men with early stage prostate cancer prior to starting cancer treatment.

• Men were provided an opportunity to use the “Healing Choices” decision support tool prior to their initial specialty consultation at Fox Chase Cancer Center. Many computer-assisted decision tools, including the one for this study, are self-guided and the individual decides how much time to spend and what sections of the tool to explore. Therefore, it is important to understand the patterns of use and the array of patterns among men with different characteristics (e.g., facility of computer use, literacy, decision preference, demographics). For example, variations might exist as a result of decision-making preferences or literacy levels. Actual web log tracking data were used to describe these patterns.

Specific aim 2: To explore patients’ experiences and perceptions of a computer assisted patient decision aid and its role in their decision-making process.

• We asked patients to describe their experiences with the software and its role in their decision-making process. We used the Preparation for Decision-Making Scale immediately after use of “Healing Choices” and in-depth semi-structured qualitative interviews approximately two weeks after the use of the decision support software. The in-depth interviews provided rich narratives about the experience using the computer assisted decision aid and perceptions of the role of the decision support software in their decision-making process.

Research questions: This exploratory study described patterns of use which ultimately will generate hypotheses for future research, rather than test hypotheses about the use of a CAPtDA for treatment decision making for early stage prostate cancer.

Findings

Specific CAPtDA components were highly utilized while other components were rarely used. The “Men’s Stories,” which included actual men’s stories about diagnoses, treatment decisions and challenges, was viewed by 77% of the men. Results showed that the percentage of men who viewed “Men’s Stories” spent almost half of their time (46%) here. In contrast, the “Notebook,” which is the values clarification tool, was viewed by only four men and they spent about one minute in this section. Men with lower levels of health literacy spent more time in the “Men’s Stories” than men with higher levels of literacy. However, literacy level was not associated with multiple uses and men reported that the content was easy to understand regardless of health literacy level. Those with higher decisional conflict spent more time using the CAPtDA, overall. Those who were less confident in their treatment choice were less likely to use the software again. Fifteen percent of the sample was minority, but there was a dramatic drop-off rate among minorities and those with limited literacy when asked to participate in the in-depth interviews. Opening this “black box” showed different patterns of use and confirmed that not everyone used this CAPtDA in the same way, or as we intended.