Decision aids for benign prostatic hyperplasia and prostate cancer

Area of Science:

• Urology
• Health Services Research
• Medical Decision Making

Background:

• Benign prostatic hyperplasia (BPH) and prostate cancer (PRCA) are common conditions in men.
• Treatment decisions for BPH and PRCA can be complex, involving various options with different outcomes.
• Patient engagement in decision-making is crucial for aligning treatment with patient preferences and values.

Purpose of the Study:

• To evaluate the impact of implementing patient decision aids (DAs) on treatment rates and healthcare costs for BPH and localized PRCA.
• To assess the association between DA use and the rates of surgery for BPH and active treatment for PRCA.
• To determine if DA implementation influences the total healthcare costs associated with managing BPH and PRCA.

Main Methods:

• A pre-post observational study design was employed in a Washington state healthcare system.
• Urologists were instructed to use DAs for all patients diagnosed with BPH or localized PRCA during an intervention period.
• Outcomes measured included 6-month rates of BPH surgery, active treatment for PRCA, and total healthcare costs, compared to a historical control period.

Main Results:

• Decision aids were delivered to 22% of men with treated BPH, 24% with untreated BPH, and 56% with PRCA.
• DA implementation correlated with a 32% reduction in BPH surgery rates for treated BPH (RR, 0.68) and a 27% reduction in active treatment for PRCA (RR, 0.73).
• No significant association was found between DA implementation and changes in healthcare costs for either BPH or PRCA.

Conclusions:

• Implementation of patient decision aids is associated with reduced rates of elective surgery for BPH and active treatment for localized PRCA.
• Despite reducing treatment rates, the studied decision aids did not lead to significant cost reductions in healthcare.
• These findings suggest that DAs can effectively support conservative management choices for BPH and PRCA, but further research may be needed to address cost implications.