Assessing the adoption of shared decision making using decision aids among urologists and prostate cancer patients

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer related deaths in American men. However, numerous studies have shown a high prevalence of overdiagnosis and overtreatment of prostate cancer. To overcome this, the United States Preventive Services Task Force and the American Urological Association have recommended against prostate cancer screening and encouraged urologists to practice shared decision making. Urologists can adopt patient decision aids which are tools designed for patients to increase their knowledge about prostate cancer and ascertain their values and preferences towards the relevant treatment options in order to help facilitate the shared decision making process in routine clinical practice. The goal of this dissertation is to understand the utilization and implementation of the practice of shared decision making and the role of patient decision aids in the field of urology, specifically among urologists treating prostate cancer patients.;In order to achieve this goal, the first part of the dissertation focused on a systematic review of the information within fourteen patient decision aids designed for patients facing prostate cancer treatment decisions. The review highlighted the variable presentation of information regarding prostate cancer and benefits/risks of treatment; the lack of involvement of urologists and patient's family members in developing decision aids; the lack of effectiveness studies for using patient decision aids in routine practice; and the varying implementation methods.;In the second part of the dissertation, twelve practicing urologists were interviewed regarding their perspectives about shared decision making and adopting patient decision aids in routine practice. None of the urologists interviewed were aware of the patient decision aids but all agreed to the potential value of using the decision aids with their patients. They described several characteristics of decision aids that could either hamper or facilitate the use of decision aids depending on their practice styles, settings and patient populations.;Finally, findings from the systematic review and the qualitative interviews were triangulated to identify instances where urologist's preferences matched with the characteristics of the existing decision aids and in many others where there was a mismatch. Based on these findings, a survey was developed with intent of measuring and assessing the barriers and facilitators of adoption and implementation of shared decision making and decision aids in routine clinical practice. In addition, the dissertation study provides recommendations for urologists and decision aids developers to increase the widespread adoption of decision aids.