Improving Informed Decision-Making for Precision Oncology in Veterans with Advanced Prostate Cancer
Abstract
Background: Men with advanced prostate cancer frequently face complex treatment decisions. This decision-making has become even more complicated with the use of genetic testing and targeted treatments based on genetic test results, a broad strategy known as precision oncology. With the growing use of precision oncology in prostate cancer, it is crucial that patients are provided accurate, understandable information and tools to support their decision-making. If patients are not well informed, they will be harmed from psychological distress, overtreatment, and undertreatment. They will not receive personalized, patient-centered care. There are several gaps in current scientific knowledge: (1) no studies have reported how well patients with prostate cancer are making precision oncology decisions and (2) no tools have been implemented to support these patients in making decisions. We seek to address these gaps in Veterans with advanced prostate cancer, a vulnerable group of patients that may particularly benefit from such tools. Veterans also represent a racially and geographically diverse population, and it is essential that decision support tools are developed and made accessible to all patients with prostate cancer in an equitable manner. Goals: (1) Understand the decisional needs of Veterans with advanced prostate cancer who face genetic testing and subsequent treatment decisions. (2) Identify potential disparities in unmet decisional needs. (3) Develop and implement a Decision Support Intervention consisting of evidence-based tools, such as consultation audio recordings, summaries, and decision aids, in a diverse population of Veterans. Applicability of the Research: This study will address two FY21 PCRCP Overarching Challenges: 1. Quality of life. Many studies have shown that patients who are conflicted about their decisions also have poor quality of life. Studies have also shown that decision support interventions improve psychological wellbeing, such as anxiety and depression and quality of life. The proposed research will develop a decision intervention that will improve Veterans’ decision-making, thereby reducing psychological distress, undertreatment, and overtreatment. This will lead to improved quality of life. We do not anticipate major risks. 2. Health equity. Studies have shown that minorities with prostate cancer are not participating in precision oncology, resulting in disparities. Promisingly, decision support is known to particularly benefit disadvantaged populations by increasing patients’ engagement, trust, and knowledge. We will develop and implement our decision support intervention at the San Francisco VA, where 30% of Veterans are non-White and many live in rural counties. By doing so, we will ensure that all Veterans can reap the benefits of decision support and that all Veterans are engaged in precision oncology, thereby reducing ongoing disparities. Long-Term Impact: During this project, we plan to engage other VA centers with a prostate cancer precision oncology program. Following the project, we hope to conduct a multi-VA implementation trial to spread our decision support intervention to other VA centers nationwide. This means that the diverse Veteran population comprising of thousands of men across the USA will receive quality of life and health equity benefits. Timeline: We expect the time to achieve patient-related outcomes such as improved knowledge, anxiety, and quality of life will be 8 years. However, we will measure implementation outcomes such as Reach and Adoption in this project, meaning San Francisco VA patients will receive the quality of life benefits within 3-4 years. My Career Goals: My goal is to become an independent physician-scientist in prostate cancer research. My research program will focus on implementation science methods to understand and improve decision-making in diverse populations of men with advanced prostate canc
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210159
Entities
People
- Daniel Kwon
Organizations
- United States Army
- University of California, San Francisco