Improving quality of life measures for use in shared decision-making in advanced prostate cancer.

Abstract

50 Background: In advanced prostate cancer (aPC), understanding patient treatment goals is the cornerstone of shared decision-making (SDM); however, complex treatment choices make this difficult. Validated patient-reported outcome measures (PROMs) capture the patient’s perspective of their health and assess treatment impacts on their quality of life (QoL). Overall, current PROMs are overly general, not individualized, and imprecise in symptom assessment, which may limit their use in populations with mild symptom burden. Although common in trials, PROMs integration in clinical practice is used less in SDM due to low rates of patient completion and clinician–patient discussion following completion. A standardized approach to effectively incorporate patient-reported QoL measures in SDM for patients with aPC is needed. Methods: An international expert panel of clinicians specializing in oncology and urology was assembled to discuss ways to enhance the incorporation of QoL measures into SDM discussions in aPC. Results: Clinicians agreed that current PROMs are valuable but insufficiently address patients’ lived experiences and treatment goals. The panel emphasized the need for a standardized and validated tool that assesses QoL in aPC, leveraging the benefits of PROMs, to apply to SDM for patient-centered discussions. Initial criteria determined that data collection should be comprehensive, adaptive to bothersome symptoms, repeated to assess patient experience over time, and include underrepresented groups. The tool should adapt based on previous answers to identify changes in patient goals or circumstances, integrate into clinical infrastructure to reduce clinician workload, and address technological barriers to allow regular patient data entry. Moreover, it must be accessible and understandable, ensuring that clinicians and patients are well-informed during SDM. Proposed concepts included the use of Computer Adaptive Tests, pretreatment measures for patient goals and a QoL baseline, and specialized questions for patients with localized vs. advanced disease. Conclusions: The findings of this panel discussion indicate that, to optimize SDM in aPC, a new approach to assess QoL measures is needed for wider uptake and standardized use in clinic, ensuring that treatment strategies align with patient goals. This requires novel technologies that facilitate data acquisition, adapt to patient concerns, integrate into clinical systems, and make complex data understandable for patients.