In men with prostate cancer, do interventions improve decision satisfaction, risk comprehension, knowledge about prostate cancer and understanding of their prognosis?
No studies specifically addressed this matter for men with known advanced prostate cancer. No studies were identified that assessed the effect of interventions on men’s risk comprehension, decision satisfaction, and understanding of their prognosis. Six randomised controlled trials and one case series have assessed the impact of intervention mainly on men’s knowledge and desire for involvement in decision making. One of these studies was of medium quality and the others were of low quality.
Davison and Degner undertook a low-quality randomised controlled trial with 60 men newly diagnosed with prostate cancer, comparing written information augmented by an audiotape of medical consultation to written information alone. Stage of disease was not described, however most men were being treated with radical prostatectomy so these were probably men with localised disease. At the six weeks post-test assessment, men who received the augmented information took a more active role in treatment decision-making compared with men who received only written information. In the group that received the audiotape, an additional 40% of men (95% CI: 18–62%, p<0.0001) took an active role at the post-test assessment.
Lepore and Helgeson undertook a low-quality randomised controlled trial with 24 men who had recently completed treatment for localised prostate cancer. The study compared six-weekly lectures plus peer discussion versus a control group. Two weeks after the intervention, men in the interventiongroup experienced greater improvements in knowledge in comparison to controls (p<0.001). In a subsequent study, Lepore et al assessed the effectiveness of group education versus group education plus peer discussion versus control in a randomised controlled trial with 250 men with mixed-stage prostate cancer. This study was of medium quality. Two weeks after the intervention, men who received group education or group education plus peer discussion experienced significantly greater improvements in knowledge compared with controls (p<0.01).
Templeton et al undertook a randomised controlled trial of an evidence-based education package supplemented with verbal teaching by a urology nurse with 55 men on hormonal manipulation. The study was of low quality and stage of disease was not assessed. Men who received the education package experienced greater improvements in knowledge and satisfaction with care in comparison to controls at one month post-intervention. The mean changes from pre- to post-test were larger in the groups receiving the education package by 6.22 (out of 14) 95% CI: 4.80 to 7.64 (p<0.0001) for disease knowledge, 4.31 (out of 10) 95% CI: 3.20 to 5.42 (p<0.001) for treatment knowledge and 3.29 (out of 32) 95% CI: 1.72 to 4.86 (p=0.0001) for satisfaction.
Flynn recruited 67 newly-diagnosed men in a case series to assess the effectiveness of multimedia education about prostate cancer and found significant improvements in overall knowledge immediately after receiving the education program (knowledge change =1.76 95% CI: 0.98 to 2.54, p<0.001). This included improvements in knowledge about cancer in general and prostate anatomy (change= 0.33, 95% CI: 0.005 to 0.61, p<0.05); disease advancement (change= 0.38 95% CI 0.12 to 0.64, p<0.01); aims and side effects of radiotherapy (change= 0.28 95% CI: 0.03 to 0.53, p<0.05), and hormone therapy (change 0.63 95% CI: 0.35 to 0.91, p<0.001). This study was of low quality. In summary, consistent improvements in men’s knowledge about prostate cancer have been achieved from a range of approaches that include written information, nurse instruction, multimedia and group education and peer discussion. The clinical impact of knowledge is unclear. However, knowledge about treatment options and effects is considered necessary for informed consent, shared decisionmaking, compliance with treatments, and self care.
Evidence summary and recommendations
|There is good evidence that men’s knowledge of prostate cancer and its treatment can be improved by educational interventions delivered through a range of methods including written and multimedia information, verbal instruction, group education and peer discussion. In addition, involvement in decision-making can be increased through the use of written information and an audiotape of the medical consultation.||II, IV||, , , , , , |
|Men with advanced prostate cancer should be offered education about their cancer, treatment options, and the benefits and disadvantages of available approaches, as well as strategies to manage treatment side effects at each stage in the progression of prostate cancer. A range of formats including written information, verbal instruction and multimedia could be considered.||C|
- Davison BJ, Degner LF. Empowerment of men newly diagnosed with prostate cancer. Cancer Nurs 1997 Jun;20(3):187-96 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9190093.
- Lepore SJ, Helgeson VS. Psychoeducational support group enhances quality of life in men with prostate cancer. Cancer Research Therapy & Control 1999;8(1-2): 81-91.
- Lepore SJ, Helgeson VS, Eton DT, Schulz R. Improving quality of life in men with prostate cancer: a randomized controlled trial of group education interventions. Health Psychol 2003 Sep;22(5):443-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14570527.
- Templeton H, Coates V. Evaluation of an evidence-based education package for men with prostate cancer on hormonal manipulation therapy. Patient Educ Couns 2004 Oct;55(1):55-61 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15476990.
- Flynn D, van Schaik P, van Wersch A, Ahmed T, Chadwick D. The utility of a multimedia education program for prostate cancer patients: a formative evaluation. Br J Cancer 2004 Aug 31;91(5):855-60 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15280915.
- Hack TF, Pickles T, Bultz BD, Degner LF, Katz A, Davison BJ. Feasibility of an audiotape intervention for patients with cancer: A multicenter, randomized, controlled pilot study. Journal of Psychosocial Oncology 1999;17(2):1-15.
- Mishel MH, Belyea M, Germino BB, Stewart JL, Bailey DE Jr, Robertson C, et al. Helping patients with localized prostate carcinoma manage uncertainty and treatment side effects: nurse-delivered psychoeducational intervention over the telephone. Cancer 2002 Mar 15;94(6):1854-66 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11920549.