Shared decision making and use of decision AIDS for localized prostate cancer : perceptions from radiation oncologists and urologists

JAMA Intern Med. 2015 May;175(5):792-9. doi: 10.1001/jamainternmed.2015.63.


Importance: The current attitudes of prostate cancer specialists toward decision aids and their use in clinical practice to facilitate shared decision making are poorly understood.

Objective: To assess attitudes toward decision aids and their dissemination in clinical practice.

Design, setting, and participants: A survey was mailed to a national random sample of 1422 specialists (711 radiation oncologists and 711 urologists) in the United States from November 1, 2011, through April 30, 2012.

Main outcomes and measures: Respondents were asked about familiarity, perceptions, and use of decision aids for clinically localized prostate cancer and trust in various professional societies in developing decision aids. The Pearson χ2 test was used to test for bivariate associations between physician characteristics and outcomes.

Results: Similar response rates were observed for radiation oncologists and urologists (44.0% vs 46.1%; P=.46). Although most respondents had some familiarity with decision aids, only 35.5% currently use a decision aid in clinic practice. The most commonly cited barriers to decision aid use included the perception that their ability to estimate the risk of recurrence was superior to that of decision aids (7.7% in those not using decision aids and 26.2% in those using decision aids; P<.001) and the concern that patients could not process information from a decision aid (7.6% in those not using decision aids and 23.7% in those using decision aids; P<.001). In assessing trust in decision aids established by various professional medical societies, specialists consistently reported trust in favor of their respective organizations, with 9.2% being very confident and 59.2% being moderately confident (P=.01).

Conclusions and relevance: Use of decision aids among specialists treating patients with prostate cancer is relatively low. Efforts to address barriers to clinical implementation of decision aids may facilitate greater shared decision making for patients diagnosed as having prostate cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Decision Making
  • Decision Support Techniques*
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local* / diagnosis
  • Neoplasm Recurrence, Local* / prevention & control
  • Practice Patterns, Physicians' / statistics & numerical data
  • Prostatic Neoplasms / diagnosis*
  • Radiation Oncology* / methods
  • Radiation Oncology* / statistics & numerical data
  • Surveys and Questionnaires
  • United States
  • Urology* / methods
  • Urology* / statistics & numerical data