BACKGROUND/RATIONALE:
Localized prostate cancer is the leading cause of cancer-related morbidity among Veterans. Treatment options differ in side effects, but no alternative is clearly advantageous in prolonging survival. Thus, patient preferences are critical considerations in the choice of treatment for localized prostate cancer. Because of an absence of existing measures of preferences appropriate for the clinical setting, we sought to generate and to provide evidence to support a new preferences instrument that could be implemented in clinical shared decision making.

OBJECTIVE(S):
The immediate objective of this project was to develop and test a practical and psychometrically strong method to assess patients' preferences. The specific aims are as follows:

Specific Aim 1. To compose an instrument, the patient preference measure, based on an expanded range of domains relevant to patient goals for prostate cancer treatment.

Specific Aim 2. To evaluate the psychometric properties of the patient preference measure.

METHODS:
To accomplish these goals, we conducted incremental studies using both qualitative and quantitative methodologies. To ensure that the measure would feasible and appropriate for use in Department of Veterans Affairs (VA) clinical settings, we recruited patients from the San Francisco VA for all phases of the research. Qualitative studies were used to generate and pretest the new patient preference measure including fourteen focus groups and twenty structured cognitive interviews. Cross-sectional and longitudinal surveys of Veterans diagnosed with prostate cancer were used to establish evidence on the measure's reliability and validity.

FINDINGS/RESULTS:
Our focus group data generated a wide range of patient considerations important in prostate
cancer treatment decisions (i.e., survival, side effects including sexual and urinary function,
responsibilities, relationships, self-esteem, treatment characteristics). Based on these
considerations, we generated and pretested a 50-item, eight subscale measure, the Values
Insight and Balance Evaluation Scale (VIBEs) Development Version. Our cross-sectional and
longitudinal studies support the VIBEs internal consistency reliability (range 0.70-0.91) and
construct validity (correlation coefficient range= -0.24 to 0.14, with coefficients in the expected
directions and magnitudes). Our construct validation studies have supported several
refinements of the measure, including a reduction in items and an expansion to an eleven
subscale version of the VIBEs.

IMPACT:
This project is significant to the health care of Veterans because of the high prevalence of prostate cancer in the Veteran population. We have developed and established a psychometrically sound instrument that is feasible for use in the clinical setting and that can quantify patient preferences for prostate cancer treatment. The measure has the potential to help patients understand and prioritize their concerns about prostate cancer treatment and to assist patients and their physicians engage in shared-decision making, an effort crucial in advancing patient-centered care and improving outcomes in the VA Health System. A next step will be to implement the measure in the VA clinical setting.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Kawakami J, Meng MV, Sadetsky N, Latini DM, DuChane J, Carroll PR. Changing patterns of pelvic lymphadenectomy for prostate cancer: results from CaPSURE. The Journal of urology. 2006 Oct 1; 176(4 Pt 1):1382-6. [view]
2. Knight SJ, Latini DM, Hart SL, Sadetsky N, Kane CJ, DuChane J, Carroll PR,. Education predicts quality of life among men with prostate cancer cared for in the Department of Veterans Affairs: a longitudinal quality of life analysis from CaPSURE. Cancer. 2007 May 1; 109(9):1769-76. [view]
3. Hart SL, Latini DM, Cowan JE, Carroll PR, CaPSURE Investigators. Fear of recurrence, treatment satisfaction, and quality of life after radical prostatectomy for prostate cancer. Supportive Care in Cancer : Official Journal of The Multinational Association of Supportive Care in Cancer. 2008 Feb 1; 16(2):161-9. [view]
4. Latini DM, Chan JM, Cowan JE, Arredondo SA, Kane CJ, Penson DF, DuChane J, Carroll PR, CaPSURE Investigators. Health-related quality of life for men with prostate cancer and diabetes: a longitudinal analysis from CaPSURE. Urology. 2006 Dec 1; 68(6):1242-7. [view]
5. Hong YM, Hu JC, Paciorek AT, Knight SJ, Carroll PR. Impact of radical prostatectomy positive surgical margins on fear of cancer recurrence: results from CaPSURE. Urologic oncology. 2010 May 1; 28(3):268-73. [view]
6. Sadetsky N, Lubeck DP, Pasta DJ, Latini DM, DuChane J, Carroll PR. Insurance and quality of life in men with prostate cancer: data from the Cancer of the Prostate Strategic Urological Research Endeavor. BJU international. 2008 Mar 1; 101(6):691-7. [view]
7. Wolf MS, Knight SJ, Lyons EA, Durazo-Arvizu R, Pickard SA, Arseven A, Arozullah A, Colella K, Ray P, Bennett CL. Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer. Urology. 2006 Jul 1; 68(1):89-93. [view]
8. Lin GA, Aaronson DS, Knight SJ, Carroll PR, Dudley RA. Patient decision aids for prostate cancer treatment: a systematic review of the literature. CA: A Cancer Journal For Clinicians. 2009 Nov 1; 59(6):379-90. [view]
9. Knight SJ. Patient-reported QOL assessment: sufficient for clinical decision-making? The journal of supportive oncology. 2008 Jun 1; 6(5):231-3. [view]
10. Sadetsky N, Elkin EP, Latini DM, DuChane J, Carroll PR, CaPSURE Investigators. Prostate cancer outcomes among older men: insurance status comparisons results from CaPSURE database. Prostate Cancer and Prostatic Diseases. 2008 Jan 1; 11(3):280-7. [view]
11. Pickard AS, Lin HW, Knight SJ, Sharifi R, Wu Z, Hung SY, Witt WP, Chang CH, Bennett CL. Proxy assessment of health-related quality of life in African American and white respondents with prostate cancer: perspective matters. Medical care. 2009 Feb 1; 47(2):176-83. [view]
12. Latini Dm, Arredondo S, Sadetsky N, Pasta DJ, Wallace KL, Carroll PR. Quality of life after second treatment for prostate cancer: Date from CaPSURE. Oncology Nursing Forum. 2007 Jan 1; 34(1):210-211. [view]
13. Arredondo SA, Latini DM, Sadetsky N, Kawakami J, Pasta DJ, DuChane J, Carroll PR, CaPSURE Investigators. Quality of life for men receiving a second treatment for prostate cancer. The Journal of urology. 2007 Jan 1; 177(1):273-8; discussion 278-9. [view]
14. Latini DM, Hart SL, Coon DW, Knight SJ. Sexual rehabilitation after localized prostate cancer: current interventions and future directions. Cancer Journal (Sudbury, Mass.). 2009 Jan 1; 15(1):34-40. [view]
15. Knight SJ, Latini DM. Sexual side effects and prostate cancer treatment decisions: patient information needs and preferences. Cancer Journal (Sudbury, Mass.). 2009 Jan 1; 15(1):41-4. [view]
16. Latini DM, Hart SL, Knight SJ, Cowan JE, Ross PL, Duchane J, Carroll PR, CaPSURE Investigators. The relationship between anxiety and time to treatment for patients with prostate cancer on surveillance. The Journal of urology. 2007 Sep 1; 178(3 Pt 1):826-31; discussion 831-2. [view]
17. Devadoss R, Green GL, Carter DN, Latini DM, Kaniu-Mwaniki P, Barker JC, Sands LP, Chren MM, Walter LC, Knight SJ. Understanding treatment related symptom outcomes among prostate cancer patients. Journal of the American Geriatrics Society. 2007 Jan 1; 55(4):S59-S59. [view]

VA Cyberseminars

1. Knight SJ. Understanding Patient Preferences in Individual Health Decisions: Conceptual and measurement considerations. [Cyberseminar]. 2009 Mar 18. [view]

Conference Presentations

1. Sadetsky N, Kneier A, Latini DM, Knight SJ, Carroll PR. A coping-skills intervention for newly-diagnosed prostate cancer patients: Results from a randomized controlled trial. Paper presented at: American Society of Clinical Oncology Prostate Cancer Annual Symposium; 2005 Sep 16; Orlando, FL. [view]
2. Knight SJ. Active Surveillance for Early Stage Prostate Cancer. Paper presented at: University of California San Francisco Comprehensive Cancer Department Active Surveillance for Early Stage Prostate Cancer International Symposium; 2007 Jan 13; San Francisco, CA. [view]
3. Knight SJ, Hart SL, Cowan JE, Ross PL, DuChane J, Carroll PR. Cancer anxiety predicts time to active treatment for men with localized prostate cancer on active surveillance: Data from CaPSURE. Paper presented at: American Society of Clinical Oncology Annual Meeting; 2006 Jun 3; Atlanta, GA. [view]
4. Fradet, Knight SJ, Carroll PR. Change over time of fear of cancer recurrence in prostate cancer survivors: Are there clinical predictors? Presented at: Genitourinary Cancer Annual Symposium; 2008 Feb 14; San Francisco, CA. [view]
5. Knight SJ, Lim E, Green GL, Latini DM, Yale MS, Chren M, Sands LP. Comprehensive assessment of Veterans preferences for prostate cancer care in the VHA: Conceptualization of the Values Insight and Balance scales. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 17; Washington, DC. [view]
6. Knight SJ, Cown JE, Carroll PR. Does Fear of Recurrence Predict Choice of Primary Treatment for Prostate Cancer? Data from the Capsure Observational Study. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2006 Mar 25; San Francisco, CA. [view]
7. Knight SJ, Latini D, Cowan JE, Carroll PR. Does Fear of Recurrence Predict Choice of Primary Treatment for Prostate Cancer? Data from the CaPSURE Observational Study. Paper presented at: Cancer Culture and Literacy Annual Conference; 2006 May 18; Tampa, FL. [view]
8. Knight SJ, Latini DM, Cowan JE, Carroll PR. Does fear of recurrence predict choice of primary treatment of prostate cancer? Data from the CaPSURE observational study. Paper presented at: Society of General Internal Medicine New England Regional Annual Meeting; 2006 Oct 16; Boston, MA. [view]
9. Knight SJ, Chren MM, Grollman J, Bennett CL. Identification of men who want help with prostate cancer treatment decisions. Paper presented at: Society for Medical Decision Making Annual Meeting; 2005 Oct 1; Atlanta, GA. [view]
10. Knight SJ. Innovative Minds in Prostate Cancer Today (IMPaCT). Paper presented at: Department of Defense Prostate Cancer Research Program Annual Meeting; 2007 Sep 8; Atlanta, GA. [view]
11. Knight SJ, Latini D, Chren MM. Patient preferences for prostate cancer care: Measurement in ethnically diverse populations. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2005 Mar 1; Boston, MA. [view]
12. Knight SJ. Patient preferences for prostate cancer treatment: A qualitative study of health state attributes. Paper presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA. [view]
13. Knight SJ, Green GL, Carter DN, Latini DM, Barker JC, Sands LP, Chren MM. Patient preferences for prostate cancer treatment: A qualitative study of health state attributes. Poster session presented at: Society for Medical Decision Making Annual Meeting; 2006 Oct 18; Boston, MA. [view]
14. Knight SJ, Latini DM, Sands LP, Carter D. Patient values and preferences for care: Methods for improving measures. Presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2007 Mar 21; Washington, DC. [view]
15. Knight SJ, Mohamed AF, Johnson FR, Marshall DA, Ladabaum U, Phillips KA, Walsh JM. Preferences for genetic testing to assess colon cancer risks. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2011 May 22; Baltimore, MD. [view]
16. Green GL, Carter DN, Latini DM, Devadoss R, Kaniu P, Barker JC, Sands LP, Chren M, Knight SJ. Prostate cancer symptoms: understanding the range and unmet needs for management. Paper presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA. [view]
17. Latini DM, Arredondo S, Sadetsky N, Pasta DJ, Wallace KL, Carroll PR. Quality of life after second treatment for prostate cancer: Data from CaPSURE. Presented at: Oncology Nursing Society Annual Congress; 2007 Apr 24; Los Angeles, CA. [view]
18. Latini DMKSJSNKCJDJCPR. Quality of life differs by education for Veterans: A Longitudinal quality of life analysis from CaPSURE. Paper presented at: American Society of Clinical Oncology Prostate Cancer Annual Symposium; 2005 Feb 1; Orlando, FL. [view]
19. Wolf, Knight, Durazo-Arvizu R. Relation between literacy, race, and PSA level among men with newly diagnosed prostate cancer. Paper presented at: American Urological Association Annual Meeting; 2005 Jan 2; San Antonio, TX. [view]
20. Sadetsky N, Latini DM, Carroll PR. Relationship between functional status and self-rated health in patients with prostate cancer: Data from CaPSURE. Presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2007 May 19; Arlington, VA. [view]
21. Hong YM, Hu JC, Paciorek AT, Knight SJ, Carroll PR. The impact of radical prostatectomy positive surgical margins on fear of cancer recurrence: Results from CaPSURE. Paper presented at: Prostate Cancer - A Multidisciplinary Approach Annual Symposium; 2007 Feb 15; Orlando, FL. [view]
22. Hong YM, Hu JC, Paciorek AT, Knight SJ, Carroll PR. The impact of radical prostatectomy positive surgical margins on fear of cancer recurrence: Results from CaPSURE. Paper presented at: American Urological Association Annual Meeting; 2007 May 5; Anaheim, CA. [view]
23. Knight SJ, Studts JL, Latini DM, Sands LP. Understanding patient preferences for prevention and treatment. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2010 Apr 7; Seattle, WA. [view]
24. Knight SJ, Mohamed AF, Marshall DA, Ladabaum U, Phillips KA, Walsh JM. Value of genetic testing for heritable disease in a population-based sample of older adults. Poster session presented at: AcademyHealth Annual Research Meeting; 2011 Jun 13; Seattle, WA. [view]
25. Green GL, Sands LP, Latini DM, Kaniu P, Barker JC, Chren MM, Knight SJ. Values Insight and Balances Scales (VIBES-PC): Psychometric Characteristics in the Prostate Cancer Clinical Setting. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2009 Apr 22; Montréal, Canada. [view]
26. Knight SJ, Latini D, Chren MM. What do African American and Caucasian men say they consider in making prostate cancer treatment decisions? A Qualitative study of treatment attributes. Paper presented at: Society of General Internal Medicine California / Hawaii Regional Annual Meeting; 2005 Oct 24; San Francisco, CA. [view]

DRA: Aging, Older Veterans' Health and Care
DRE: Treatment - Observational
Keywords: Cancer, Patient preferences, Prostate disease
MeSH Terms: Decision Making, Prostatic Neoplasms, Quality of Life, Patient-Centered Care, Patient Satisfaction, Patient Participation