Background: Men with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges\nof men�s preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision\naids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of\ntwo strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a)\nPtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use.\nMethods/design: Guided by the Knowledge to Action Framework, this comparative case study will be conducted\nusing administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in\nOntario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized\nprostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation\noncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each\nsetting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will\nbe determined from administrative data. Factors associated with receiving the PtDA will be explored using\nmultivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean\nand standard deviation (men�s decisional conflict) and frequency and proportions (practitioners consulted, uptake of\ntreatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will\nbe calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression.\nFactors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic\nanalysis of interview transcripts.\nDiscussion: Determining how to embed PtDAs effectively within clinical pathways for men with localized prostate\ncancer is essential. PtDAs have the potential to strengthen men�s active role in making prostate cancer decisions,\nenhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers\nand knowledge users will use findings to improve current PtDA use and consider scaling-up implementation.
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