Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variationReportar como inadecuado




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Implementation Science

, 11:87

First Online: 02 July 2016Received: 21 May 2016Accepted: 03 June 2016DOI: 10.1186-s13012-016-0451-1

Cite this article as: Stacey, D., Taljaard, M., Smylie, J. et al. Implementation Sci 2015 11: 87. doi:10.1186-s13012-016-0451-1

Abstract

BackgroundMen with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges of men’s preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision aids PtDAs can support men with decisions about localized prostate cancer. This is a comparative case study of two strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating a PtDA use; b impact on men, practitioners, and health system outcomes; and c factors influencing sustained use.

Methods-designGuided by the Knowledge to Action Framework, this comparative case study will be conducted using administrative data, interviews, and surveys. Cases will be bound by geographic location one hospital in Ontario; province of Saskatchewan and time. Eligible participants will be all men newly diagnosed with localized prostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation oncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each setting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will be determined from administrative data. Factors associated with receiving the PtDA will be explored using multivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean and standard deviation men’s decisional conflict and frequency and proportions practitioners consulted, uptake of treatment. To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will be calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression. Factors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic analysis of interview transcripts.

DiscussionDetermining how to embed PtDAs effectively within clinical pathways for men with localized prostate cancer is essential. PtDAs have the potential to strengthen men’s active role in making prostate cancer decisions, enhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers and knowledge users will use findings to improve current PtDA use and consider scaling-up implementation.

KeywordsImplementation science Patient decision aid Prostate cancer Comparative case studies Study proposal Electronic supplementary materialThe online version of this article doi:10.1186-s13012-016-0451-1 contains supplementary material, which is available to authorized users.

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Autor: Dawn Stacey - Monica Taljaard - Jennifer Smylie - Laura Boland - Rodney H. Breau - Meg Carley - Kunal Jana - Larry Peckfo

Fuente: https://link.springer.com/







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