Advanced Prostate Cancer Decision Support through C PREFS (CANCER PREFERENCE REFLECTION AND ELICITATION FOR FAMILY SUPPORT)

OBJECTIVES: Prostate cancer patients who have metastatic disease face a terminal diagnosis, often with multiple palliative treatments available. Ensuring treatment decisions reflect patient preferences can be complicated by factors such as declining patient capacity, which can lead to increased reliance on proxy decision makers. Proxy decision makers in this position have been shown to experience negative outcomes, such as stress, anxiety, and depression. A quantitative measure of the patients’ preferences may be useful to create support interventions for patients and families and for future research to inform policymakers and clinicians. We set out to construct a discrete choice experiment to measure patient preferences for palliative anti-cancer treatment with the eventual goal of testing the instrument's usefulness in a clinical setting.

METHODS: We are conducting semi-structured interviews and a Q sort activity with metastatic prostate cancer patients and supporters. African American patients were intentionally oversampled to support representation of a group impacted by cancer disparities. Important attributes of palliative anti-cancer treatment decisions and trade-offs that patients and their supporters make were identified and ranked using qualitative descriptive and quantitative analyses.

RESULTS: Preliminary results reveal patients and supporters identify their choice of institution and provider as among the most important attributes of their treatment decisions. In addition, participants identified the importance of the effect of treatment on longevity, emotional effects of metastatic prostate cancer treatment, logistics of availing treatment, pecuniary considerations such as insurance coverage and potential medical debt, and having an active strategy to manage their cancer.

CONCLUSIONS: These results provide context for the development of a discrete choice experiment that is intended to support the cancer decision making process for patients and their proxy decision makers.