Patient Decision-making About Precision Oncology in Veterans With Advanced Prostate Cancer

Proportion of participants with correct responses on where participants response with an agree or disagree to each item addressing information they have received regarding germline testing. The proportion of participants who correctly responded to each knowledge item receive a score of 1 for a total score range of 0 - 16. Mean score and 95% CI of the total knowledge scale will be reported.

The mean change in germline testing knowledge score from baseline to 7 days post appointment will be reported for participants in Stage 3. Participants with correct responses on where participants response with an agree or disagree to each item addressing information they have received regarding germline testing. The correct response to each knowledge item receives a score of 1 for a total score range of 0 - 16. Mean change in score and 95% CI of the total knowledge scale will be reported.

The germline testing knowledge scale is a 16 item survey where participants response with an agree or disagree to each item addressing information they have received regarding germline testing. The proportion of participants who correctly responded to each knowledge item and 95% CI for each knowledge item will be reported.

The somatic testing knowledge scale is a 17-item survey where participants response with an True, false, or don't know to each item addressing information they have received regarding personalized cancer therapy and molecular testing (target therapy). The proportion of participants who correctly responded to each knowledge item receive a score of 1 for a total score range of 0 - 17. Mean score and 95% CI of the total knowledge scale will be reported.

The somatic testing knowledge scale is a 16-item survey where participants response with an True, false, or don't know to each item addressing information they have received regarding personalized cancer therapy and molecular testing (target therapy). The proportion of participants who correctly responded to each knowledge item will be reported with 95%confidence intervals.

The collaboRATE scale is a 3 item scale with responses ranging from 0 -10 for each item which ask the participant to think about the appointment they just had. These responses will be scored using the Top Score approach which excludes cases where a response to one or more of the collaboRATE questions is missing. Each encounter is coded as either '1', if the response to all three collaboRATE items was 9, or '0' if the response to any of the three collaboRATE items was less than 9. The percentage of all encounters that were coded as '1' is the collaboRATE Score. Higher scores represent more shared decision making. This number also corresponds to the proportion of patients for whom there was 'gold standard' shared decision making. Percentage and 95% CI will be calculated.

The Brief Decision Support Analysis Tool (DSAT-10) will be used to evaluate treating physicians' and practitioners' use of decision support and communication skills for recordings (Guimond, et al. Patient Education Counsel 2003). Encounters are reviewed and scored on 5 factors such as Decision making status, Knowledge of, Values/Preference associated with, Others' involvement with the decision, and Next Steps and given a score ranging from 1-10, with a higher score indicating a greater quality of decisional support.The DSAT-10 will be applied to calculate a mean and 95% CI of the total score (0-10) and of the 5 factors.

In addition,to the regular germline testing questionnaire, the following provider communication items will be scored as Yes or No, based on 1.2022 National Comprehensive Cancer Network (NCCN) guidelines for pre-test germline testing: Prepare patient for possible outcomes of testing, including positive, negative, and variant of uncertain significance (VUS), Discuss possible management options if a mutation is identified, Advise about possible inherited cancer risk to relatives. Discuss cost of testing, Provide overview of current legislation regarding genetic, discrimination, Provide overview of current legislation regarding privacy of genetic, information, Discuss plan for results disclosure. Proportion of providers who responded yes to each item will be reported.

In addition,to the regular germline testing questionnaire, the following provider communication item will be scored as Yes or No, based on 1.2022 NCCN guidelines for pre-test tumor testing: Prepare patient for possible outcomes of testing. Proportion of providers who responded yes will be reported.

The proportion of participants who received the precision oncology intervention or testing discussed during appointment as well as the type of intervention (germline, somatic, or targeted therapy) will be reported.

The Decisional Conflict Scale measures personal perceptions of : a) uncertainty in choosing options; b) modifiable factors contributing to uncertainty such as feeling uninformed, unclear about personal values and unsupported in decision making; and c) effective decision making such as feeling the choice is informed, values-based, likely to be implemented and expressing satisfaction with the choice. Scoring and interpretation Items are given a score value ranging from 0 = 'strongly disagree' to 4 = 'strongly agree'. Total Scores are a sum of the scores of the 16 items and are scaled by divided by 16 and then multiplied by 25 for a total scale score range from 0 [extremely high decisional conflict] to 100 [no decisional conflict]. Mean score change and 95% confidence interval (CI) of the total DCS as well as the 4 subscales will be calculated between baseline and 7 days post appointment.

Adoption will be measured by the proportion of research staff and providers who agree to participate in the patient-directed decision support intervention divided by the number of invited providers.

The proportions of research staff who complete each component of the patient-directed decision support intervention for each eligible patient-participant:1) decision aid platform preference assessment; 2) decision aid delivery; 3) question list coaching; 4) summary and question routing; and 5) reminder message sending, measured by verbal questionnaire.

The proportions of providers who complete each component of the provider-directed decision support intervention for each patient-participant: 1) teach back; 2) review and/or solicit questions; 3) discuss benefits of germline testing; and 4) discuss risks of germline testing, measured by analyzing the consultation audio recording.

The proportion of patient-participants who completely review the decision aid, measured by user analytics 7 days post-appointment will be reported.

The proportion of patient-participants who request training to audio-record their appointment who then create an audio recording, measured by questionnaire 7 days post-appointment will be reported.

The proportion of all patient-participants who request question list coaching and who then ask at least one question from the question list during their appointment, as measured by analyzing the consultation audio recording will be reported.

The Net Promoter Score is a single item measure used to gauge satisfaction, and enthusiasm for the intervention. Total response options range from 0-10, with participants who select a response of 9 or 10 to be considered 'promoters". Responses will be obtained by questionnaire, 7 days post-appointment and the proportion of participants who respond with a choice of 9 or 10 will be reported.

The proportion of patient-participants who report "somewhat helpful" or "very helpful" in their evaluation of the patient-directed intervention, and each of its components, on 5-point Likert scale with responses options of "not helpful at all", "somewhat not helpful", "neither helpful nor not helpful", "somewhat helpful", and "very helpful" measured by questionnaire. 7 days post-appointment will be reported.

The proportion of provider-participants who report "somewhat" or "strongly agree" with the acceptability, feasibility, compatibility, simplicity, and relative advantage of the interventions, on a 5-point Likert scale with responses options of "strongly disagree", "somewhat disagree", "neither agree or disagree", "somewhat agree", and "strongly agree" measured by questionnaire.

Proportion of patient-participants who consent to germline testing, by medical record review.