BACKGROUND/RATIONALE:
Localized prostate cancer is the leading cause of cancer-related morbidity among Veterans. Treatment options differ in side effects, but no alternative is clearly advantageous in prolonging survival. Thus, patient preferences are critical considerations in the choice of treatment for localized prostate cancer. From our previous work, we have concluded that, first, patients desire to have their preferences considered in prostate cancer care, second, there are serious inadequacies in clinicians' understanding of patient preferences, and, third, there is inadequate evidence for the validity and reliability of current preference assessment methods to support their use by clinicians and patients in individual decision making. These conclusions have led to the current project.
OBJECTIVE(S):
The immediate objective of this project is to develop and test a practical and psychometrically strong method to assess patients' preferences. The specific aims are as follows:
Specific Aim 1. To compose an instrument, the patient preference measure, based on an expanded range of domains relevant to patient goals for prostate cancer treatment.
Specific Aim 2. To evaluate the psychometric properties of the patient preference measure.
METHODS:
To accomplish these goals, we are conducting incremental studies using both qualitative and quantitative methodologies. To ensure that the measure is feasible and appropriate for use among Veterans cared for in the Department of Veterans Affairs Health System, we are recruiting participants from the San Francisco VA for all phases of the research. Also, we are recruiting participants from the University of California at San Francisco to ensure a sample that is broad in socioeconomic status and that represents more than one health care system. Initial qualitative studies have included focus groups comprised of prostate cancer patients and their spouses. Based on the focus group data, we generated items and subscales for the measure, the Values Insight and Balance Evaluation Scale (VIBEs). We tested the VIBEs in individual structured cognitive interviews to refine the content and language used in the items and scale. We are now recruiting 600 patient participants for cross-sectional and longitudinal studies to establish evidence that the measure's validity and reliability. We will conduct focus groups with clinicians to design the VIBEs score report.
FINDINGS/RESULTS:
This project was initiated on April 1, 2004. Findings of the qualitative studies suggest that low income men with localized disease cared for in the VA consider a broad range of concerns in making prostate cancer treatment decisions. In addition to survival, and urinary and sexual function, men weigh the impact of treatment on work and family responsibilities, social relationships, and self-esteem. African American and Caucasian American men described similar considerations in making treatment decisions, suggesting that a single measure of preferences could be constructed that would be valid for both groups. However, African Americans differed from Caucasian Americans in their descriptions of the decision making process. African Americans described prostate cancer as a stigmatized disease that occurred mainly in African American men, with stigma making it difficult to discuss the disease with others and to obtain information about its treatment. Based on the focus group data, we generated items and subscales for the measure, the Values Insight and Balance Evaluation Scale (VIBEs). We tested the VIBEs in individual structured cognitive interviews to refine the content and language used in the items and scale. We are now recruiting 600 patient participants for cross-sectional and longitudinal studies to establish evidence that the measure's validity and reliability. We will conduct focus groups with clinicians to design the VIBEs score report.
IMPACT:
This project is significant to the health care of Veterans because of the high prevalence of prostate cancer among older men. Our work to develop and establish a psychometrically sound instrument that will quantify patient preferences in prostate cancer will permit physicians to incorporate patient goals and values in the treatment decision making process-an effort crucial in advancing patient-centered care and improving outcomes in the VA Health System.
Publications: We presented initial findings from the qualitative studies at the 2005 Society of Behavioral Medicine meeting in Boston, the 2005 Society of Medical Decision Making in San Francisco, the 2006 Society of Behavioral Medicine meeting in San Francisco, and the 2006 Society of Medical Decision Making annual meeting in Boston.
Published Abstracts:
Knight, SJ, Measuring Patient Preferences in Diverse Populations. (April 2005). Paper presented as a part of a symposium at the annual meeting of the Society of Behavioral Medicine in Boston, MA.
Knight, SJ, Latini, DM, Chren, MM. (October 2005). What do African American and Caucasian American men consider in making prostate cancer treatment decisions? A qualitative study of treatment attributes. Poster presented at the annual meeting of the Society of Medical Decision Making in San Francisco, CA.
Knight, SJ. (March 2006). African American Men's Experiences Making Prostate Cancer Treatment Decisions. Paper presented as a part of a symposium at the annual meeting of the Society of Behavioral Medicine in San Francisco, CA.
Knight, SJ, Green, GL, Carter, DN, Latini, DM, Barker, JC, Sands, LP, Chren, MM. (October, 2006). Patient preferences for prostate cancer treatment: A Qualitative study of health state attributes. Annual Meeting of the Society for Medical Decision Making, Boston, MA.
Knight, SJ, Green, GL, Carter, DN, Latini, DM, Barker, JC, Sands, LP, Chren, MM. (February, 2007). Patient preferences for prostate cancer treatment: A qualitative study of health state attributes. 2007 Department of Veterans Affairs Health Services Research and Development National Meeting in Arlington, VA.
Green, GL, Carter, DN, Latini, DM, Devadoss, R, Kaniu-Mwaniki, P, Barker, JC, Sands, LP, Chren, MM, Knight, SJ. (February, 2007). Symptoms following prostate cancer diagnosis and care: Expanding the range and identifying needs for symptom management. 2007 Department of Veterans Affairs Health Services Research and Development National Meeting in Arlington, VA.
Knight, SJ, Latini, DM, Sands, LP, & Carter, D. (March, 2007). Patient values and preferences for care: Methods for improving measures. 2007 Society of Behavioral Medicine Meeting in Washington, D.C.
Devadoss, R, Green, GL, Carter, DN, Latini, DM, Kaniu-Mwaniki, P, Barker, JC. Sands, LP, Chren, MM, Walter, LC, Knight, SJ. (2007). Understanding treatment-related symptom outcomes among prostate cancer patients. Journal of the American Geriatrics Society, 55, S59.
PUBLICATIONS:
Journal Articles
- Knight SJ. Patient-reported QOL assessment: sufficient for clinical decision-making? Journal of Supportive Oncology. 2008; 6(5): 231-3.
- Knight SJ, Latini DM, Hart SL, Sadetsky N, Kane CJ, DuChane J, Carroll PR, Education predicts quality of life among men with prostate cancer cared for in the Department of Veterans Affairs: a longitudinal quality of life analysis from CaPSURE. Cancer. 2007; 109(9): 1769-76.
- Arredondo SA, Latini DM, Sadetsky N, Kawakami J, Pasta DJ, DuChane J, Carroll PR, CaPSURE Investigators. Quality of life for men receiving a second treatment for prostate cancer. Journal of Urology. 2007; 177(1): 273-8; discussion 278-9.
- Holland JC, Andersen B, Breitbart WS, Dabrowski M, Dudley MM, Fleishman S, Foley GV, Fulcher C, Greenberg DB, Greiner CB, Handzo RG, Jacobsen PB, Knight SJ, Learson K, Levy MH, Manne S, McAllister-Black R, Peterman A, Riba MB, Slatkin NE, Valentine A, Zevon MA, NCCN. Distress management. Journal of the National Comprehensive Cancer Network. 2007; 5(1): 66-98.
- Latini Dm, Arredondo S, Sadetsky N, Pasta DJ, Wallace KL, Carroll PR. Quality of life after second treatment for prostate cancer: Date from CaPSURE. Oncology Nursing Forum. 2007; 34(1): 210-211.
- Kawakami J, Meng MV, Sadetsky N, Latini DM, DuChane J, Carroll PR. Changing patterns of pelvic lymphadenectomy for prostate cancer: results from CaPSURE. Journal of Urology. 2006; 176(4 Pt 1): 1382-6.
