Veterans' Decision Making for Prostate Cancer Germline Testing After Informed Consent With Their Oncologist: A...

Area of Science:

• Oncology
• Genetics
• Health Services Research

Background:

• Germline testing is recommended for advanced prostate cancer (PCa) to guide treatment and assess hereditary risk.
• Informed consent is crucial for patients undergoing germline testing.

Purpose of the Study:

• To evaluate whether Veterans Affairs (VA) patients with advanced PCa made informed decisions about germline testing.
• To assess oncologist communication during informed consent discussions.

Main Methods:

• Mixed-methods study involving audio-recorded patient-oncologist discussions.
• Administration of Decisional Conflict Scale (DCS) and KnowGene scale.
• Interviews with patients, caregivers, and providers.

Main Results:

• 85% of participants agreed to germline testing, with low overall decisional conflict.
• Oncologists frequently failed to communicate key informed consent elements; patients lacked knowledge, particularly regarding harms and outcomes.
• Barriers included limited provider time and resources; facilitators included patient-centered communication and trust in the VA.

Conclusions:

• Despite low decisional conflict, some patients made uninformed germline testing decisions.
• Recommendations include enhanced provider training in informed consent and shared decision-making, increased workforce capacity, and improved patient educational resources.