Presentation Authors: James Kearns*, Charlotte, NC, Marshall Brown, Anna Faino, Seattle, WA, Matthew Cooperberg, San Francisco, CA, Yingye Zheng, Lisa Newcomb, Daniel Lin, John Gore, Seattle, WA
Introduction: Patient-centered delivery of healthcare and shared decision-making have become increasingly important concepts over the past several decades, yet current tools lack critical information for risk counseling. We sought to develop a risk calculator that provides clinicians and patients with contextualized risk estimates for upgrading on biopsy while enrolled in AS. We sought to develop and evaluate the usability of a risk calculator interface that would convey personalized information regarding risk of upgrading on AS.
Methods: A risk calculator was developed that included increased contextual information regarding an individual patient's risk, including how specific variables compared with the model cohort and the patient's relative risk compared to other similar men. The usability of this calculator was then assessed among urologists using case-based scenarios. A survey was sent to urology residents, fellows, and attendings. We assessed accuracy in interpreting the calculator and participant-rated clinical usefulness of the calculator.
Results: The individual risk calculator has 3 columns: 1) patient variables; 2) how the patient's values compare with the cohort; and 3) the patient's relative risk compared with the cohort (Figure 1). There were 17 respondents to the usability survey (5 residents, 3 fellows, 9 attendings). Among attending urologists, 78% had completed oncology-focused fellowships. Accuracy for interpreting individual patient outcomes was 92%. Clinicians were confident in their ability to use the calculator 70% of the time. Overall, 70% of respondents stated that such a risk calculator would be useful in clinical practice.
Conclusions: The PASS Risk Calculator interface improves upon previously-published risk calculators for prediction of upgrading on AS by providing more personalized tailored information to both clinicians and patients. The interface derives from a new model for risk prediction. More work is required to determine if clinical implementation of the risk calculator is associated with improved patient-centered outcomes related to decision-making on AS.
Source of Funding: Canary Foundation, NIH grants R01CA181605 and P50CA097186, the Institute for Prostate Cancer Research, and the Department of Defense Prostate Cancer Research Program grant W81XWH1410595