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Decision Aids for Benign Prostatic Hyperplasia and Prostate Cancer

David Arterburn, MD, MPH; Robert Wellman, MS; Emily O. Westbrook, MHA; Tyler R. Ross, MA; David McCulloch, MD; Matt Handley, MD; Marc Lowe, MD; Chris Cable, MD; Steven B. Zeliadt, PhD; and Richard M. Hoffman, MD, MPH
Implementing patient decision aids was associated with lower rates of elective surgery for benign prostatic hyperplasia and of active treatment for localized prostate cancer.
The prevalence of BPH and PRCA is increasing in the aging US population. Implementing video-based DAs for BPH and localized PRCA in a large, multi-site urology group practice setting was associated with lower rates of elective surgery for previously treated BPH and of active treatment for localized PRCA. More research is needed to better understand whether large-scale implementation of these tools can improve the quality of patients’ decisions, their quality of life, and their satisfaction with care, and if they can help mitigate the risks and costs of surgical intervention over the long term.

Acknowledgments

The authors wish to thank the following individuals for the contributions to the overall implementation project and research: Scott Birkhead, Jan Collins, Andrea Lloyd, Charity McCollum, Karen Merrikin, Marc Mora, Tiffany Nelson, Carolyn Rutter, Michael Soman, and Stan Wanezek.

Author Affiliations: Group Health Research Institute (DA, RW, EOW, TRR), Seattle, WA; Group Health Physicians (DM, MH, ML, CC), Seattle, WA; Northwest HSR&D Center of Excellence, VA Puget Sound Health Care System (SBZ), Seattle, WA; Department of Medicine, University of New Mexico, Albuquerque, and Medicine Service, New Mexico VA Health Care System (RMH), Albuquerque, NM.

Source of Funding: This work was funded by The Commonwealth Fund (Grant #20080479), the Informed Medical Decisions Foundation (Grant #0103), and the Group Health Foundation. The decision aids used in this study were provided by Health Dialog, Inc. The authors had full access to all of the data and the funders did not have control over manuscript drafting or publication.

Author Disclosures: Dr Arterburn has received other research funding, and both Drs Arterburn and Hoffman have received salary support and reimbursement for meeting/conference attendance as medical editors for the not-for-profit Informed Medical Decisions Foundation, which develops content for patient education programs, including the BPH and prostate cancer programs that were the subject of this study. The Foundation has an arrangement with a for-profit company, Health Dialog, to coproduce and market these programs to healthcare organizations. Drs Arterburn and Hoffman have no relationship with any company making products for the treatment of prostate disease. Ms Westbrook has attended meetings/conferences for the Informed Medical Decisions Foundation. Mr Ross is an employee at Group Health, where the intervention took place. In addition, the intervention has potential utilization and cost benefit for Group Health. Drs Lowe, Handley, McCulloch, and Cable, and Mr Wellman report no conflicts of interest.

Authorship Information: Concept and design (DA, CC, MH, EW); acquisition of data (DA, CC, MAL, TRR, EW); analysis and interpretation of data (DA, DKM, RDW); drafting of the manuscript (DA, CC, RH); critical revision of the manuscript for important intellectual content (DA, MH, RH, MAL, DKM, EW); statistical analysis (DA, RDW); provision of study materials or patients (DA); obtaining funding (DA, EW); administrative, technical, or logistic support (DA, CC, MH, TRR, EW); and supervision (DA, MAL, TRR).

Address correspondence to: David Arterburn, MD, MPH, Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101. E-mail: arterburn.d@ghc.org.
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