Promoting Shared Decision Making Through a Tailored Decision AidPROJECT SUMMARYMany medical decisions are preference-sensitive, with the best choice depending in part on patient attitudestowards the risks and benefits of treatment alternatives. For example, the best treatment for a man withlocalized prostate cancer may depend on how strongly he wants to avoid the chance of impotence, or on howdetermined he is to physically remove the cancer from his body. An ideal decision, therefore, will be made withfull awareness of patient preferences. Research is needed to determine the best methods for helping patientscommunicate their preferences to their physicians. Using a two-phase strategy, we will test methods forincreasing patients' willingness and ability to discuss their preferences and for improving the concordancebetween their desires for shared decision making and the type of participation they experience. In Phase I, wewill conduct Internet studies to test several novel ways of tailoring a prostate cancer decision aid (DA), with thegoal of identifying interventions that increase the perceived salience of patient preferences. After we havedetermined the best interventions, we will modify our current prostate cancer DA accordingly. Phase II will thencompare this new tailored DA to our current untailored decision aid in men with newly diagnosed localizedprostate cancer. This study will be conducted at two hospitals (University of Michigan and Ann Arbor VA) andwill recruit men at the time of their prostate biopsy. Effectiveness of the tailored DA will be determined usingboth quantitative and qualitative methods. Primary quantitative outcome measures include self-efficacy andintentions for communicating treatment preferences to physician, preference for participating in the decision,concordance of desired and actual participation in the decision, and patients' perceptions of their interactionwith their physicians. We will also analyze conversations between patients and physicians to examine whetherthe tailored DA has an impact on the interaction between patients and physicians (e.g., discussion of patients'preferences). Finally, we will use eye-tracking studies as another method of accessing patient engagementwith the DA. The results of this study allow us to have unprecedented data about how to design DAs toimprove patient-physician communication. This will result in patients making more informed decisions, which inturn could result in better physical and psychological outcomes for patients.
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