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Research project: True Nth UK Decision Support: Understanding consequences of prostate cancer treatments (Cl: Brindle)

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Although the principles of autonomy and patient involvement in medical decision-making attract broad support from NHS clinicians and service providers, in reality patients can be faced with complex decisions that involve weighing a number of potential outcomes of treatment, at a time when they are experiencing the emotional impact of a cancer diagnosis. The Understanding Consequences projects iswill developing and evaluatinge a complex intervention to improve men’s understanding of the implications of a localised prostate cancer diagnosis, support informed decision-making about treatments, and reduce treatment decision regret.

TrueNth Prostate Cancer

This mixed method study used a service development model to develop and evaluate a complex intervention to improve patients’ understandings of the consequences of low-intermediate risk prostate cancer and its treatments. The Understanding Consequences Programme incorporates 3 evidence-based components: a clinical training package for clinicians, signposting to patient decision aids, and provision of audio-recordings of consultations.

The Programme was developed at two clinical sites (study 1), and evaluated at a further two sites (study 2).

The Development study (study 1) co-developed and provided feedback on iterations of the training package, methods for providing patients access to audio-recordings of consultations, methods for signposting to a patient decision-aid, and the use of patient-reported outcomes measures. Interviews with clinicians and patients  informed changes to all components of the Programme.

A controlled cohort design with post-test measures was used to evaluate the Programme at the Implementation (Evaluation) study sites (Study 2).

The Programme measured 1) patient-reported outcomes (decisional conflict, decision quality, decision regret, quality of communication and understanding of consequences) using a questionnaire, 2) access to audio-recordings of consultations, and 3) access to patient decision aids, of 75 men pre- and 75 post-implementation. Outcomes were compared between the two cohorts; the cohort who received the Understanding Consequences Programme, and the cohort who received usual care.

Questionnaire data was collected at 2 time points: at the time of treatment decision and 8 months after recruitment.  

Next steps: The Understanding Consequences Programme has now been evaluated at two sites and the clinical training package is being refined prior to implementation. Patient information booklets are available for implementation by clinical teams. Please contact Lucy Brindle ( for further information.

Funder: True Nth (Prostate Cancer UK and Movember)

Associated research themes

  • Low risk prostate cancer
  • Active surveillance
  • Intermediate risk prostate cancer
  • Localised prostate cancer
  • Shared decision making
  • Preference-sensitive treatment decisions
  • Decision support
  • Patient Decision Aids
  • Clinical Communication Training
  • Conversation Analysis
  • Developing and evaluating complex interventions

Related research groups

Complex Healthcare Processes
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