Use of a web-based decision aid for men diagnosed with early-stage prostate cancer: Results from a web tracking study

Background: Web-based decision aids are important tools to address informed decision making. Objective/Purpose: This mixed methods study described patterns of use of a web tool among men with early stage prostate cancer and explored their perceptions of a web tool and its role in their decision-making process. Methods: Men (N=56) with early stage prostate cancer, seeking consultations for surgery and/or radiation therapy at a comprehensive cancer center, were recruited by telephone. Those who consented completed a background questionnaire prior to their initial treatment consult. Variables included demographics, decisional factors (such as decision-making style, treatment preference, stage of decision making, decisional conflict) and health communication factors. The web tool had embedded web tracking capabilities. Men (N=25) were also asked to participate in an in-depth qualitative interview within 2-4 weeks after their consult visit. Results: Specific web tool components were more highly utilized while other components were rarely used. The Men's Stories, with actual men's' stories about their diagnosis, treatment decision and challenges, was viewed by 77% of the men and they spent almost half of their time here. In contrast, the Notebook, which is the values clarification tool, was viewed by only 4 men and they spent about one minute in this section. Men with lower levels of health literacy spent more time in the Men's Stories than men with higher levels of literacy. Those with higher decisional conflict spent more time overall and those who were less confident in their treatment choice were less likely to use it again. Fifteen percent of the sample was minority, but the drop-off rate in participation in the in-depth interviews among minorities and those with limited literacy was dramatic. Discussion/Conclusions: Opening this “black box” showed different patterns of use and confirmed that not everyone uses it in the same way, or as we intend.