Effects of a Patient Decision Aid for Nonmetastatic Prostate Cancer Established in Routine Care: The Randomized Controlled EvEnt-PCA Trial

Johannes Huber¹, Philipp Karschuck², Rainer Koch¹, Andreas Ihrig³, Tanja Krones⁴, Andreas Neisius⁵, Sven von Ahn⁵, Christian Klopf⁶, Steffen Weikert⁶, Michael Siebels⁷, Nicolas Haseke⁷, Christian Weißflog⁸, Martin Baunacke⁹, Peter Liske¹⁰, Georgi Tosev¹¹, Thomas Benusch¹², Martin Schostak¹³, Joachim Stein¹⁴, Philipp Spiegelhalder¹⁵, Christian Thomas⁹, Cem Aksoy¹, Luka Flegar¹, Christer Groeben¹⁶; EvEnt-PCA Study Group

Affiliations

¹ Department of Urology, Medical Centre, University of Heidelberg, Heidelberg, Germany; Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
² Department of Urology, Medical Centre, University of Heidelberg, Heidelberg, Germany; Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany. Electronic address: philipp.karschuck@med.uni-heidelberg.de.
³ Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, Heidelberg, Germany.
⁴ Institute of Biomedical Ethics and History of Medicine University of Zürich, University Hospital Zürich, Zürich, Switzerland.
⁵ Department of Urology, Brüderkrankenhaus Trier, Trier, Germany.
⁶ Department of Urology, Alexianer St. Hedwig-Krankenhaus, Berlin, Germany.
⁷ Urological Joint Practice Urologie Pasing Prof. Dr. med. Michael Siebels & Dr. med. Nicolas Haseke, Munich, Germany.
⁸ Urological Joint Practice am Weißen Hirsch, Dresden, Germany.
⁹ Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
¹⁰ Urological Practice Dr. Gnann und Dr. Liske, Stuttgart, Germany.
¹¹ Department of Urology, Medical Centre, University of Heidelberg, Heidelberg, Germany; Urological Practice, Mannheim, Germany.
¹² Urological Practice, Neustadt/Saxony, Germany.
¹³ Department of Urology, Uro-Oncology, Robot-Assisted and Focal Therapy, University of Magdeburg, Magdeburg, Germany; LOGICURO, Berlin, Germany.
¹⁴ KRH Klinikum Großburgwedel, Department of Urology, Burgwedel, Germany.
¹⁵ Urological Joint Practice Urologie Neandertal, Mettmann, Germany.
¹⁶ Department of Urology, Medical Centre, University of Heidelberg, Heidelberg, Germany; Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; Department of Urology, Philipps-University Marburg, Marburg, Germany.

PMID: 40925814
DOI: 10.1016/j.euf.2025.07.019

Free article

Effects of a Patient Decision Aid for Nonmetastatic Prostate Cancer Established in Routine Care: The Randomized Controlled EvEnt-PCA Trial

Johannes Huber et al. Eur Urol Focus. 2025.

Free article

. 2025 Sep 8:S2405-4569(25)00243-3.

doi: 10.1016/j.euf.2025.07.019. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, Medical Centre, University of Heidelberg, Heidelberg, Germany; Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
² Department of Urology, Medical Centre, University of Heidelberg, Heidelberg, Germany; Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany. Electronic address: philipp.karschuck@med.uni-heidelberg.de.
³ Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, Heidelberg, Germany.
⁴ Institute of Biomedical Ethics and History of Medicine University of Zürich, University Hospital Zürich, Zürich, Switzerland.
⁵ Department of Urology, Brüderkrankenhaus Trier, Trier, Germany.
⁶ Department of Urology, Alexianer St. Hedwig-Krankenhaus, Berlin, Germany.
⁷ Urological Joint Practice Urologie Pasing Prof. Dr. med. Michael Siebels & Dr. med. Nicolas Haseke, Munich, Germany.
⁸ Urological Joint Practice am Weißen Hirsch, Dresden, Germany.
⁹ Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
¹⁰ Urological Practice Dr. Gnann und Dr. Liske, Stuttgart, Germany.
¹¹ Department of Urology, Medical Centre, University of Heidelberg, Heidelberg, Germany; Urological Practice, Mannheim, Germany.
¹² Urological Practice, Neustadt/Saxony, Germany.
¹³ Department of Urology, Uro-Oncology, Robot-Assisted and Focal Therapy, University of Magdeburg, Magdeburg, Germany; LOGICURO, Berlin, Germany.
¹⁴ KRH Klinikum Großburgwedel, Department of Urology, Burgwedel, Germany.
¹⁵ Urological Joint Practice Urologie Neandertal, Mettmann, Germany.
¹⁶ Department of Urology, Medical Centre, University of Heidelberg, Heidelberg, Germany; Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; Department of Urology, Philipps-University Marburg, Marburg, Germany.

PMID: 40925814
DOI: 10.1016/j.euf.2025.07.019

Abstract

Background and objective: Since 2016, >21 000 patients with prostate cancer (PC) used our personalized online decision aid in routine care in Germany. We analyzed the effects of this online decision aid for men with nonmetastatic PC in a randomized controlled trial.

Methods: In the randomized controlled EvEnt-PCA trial, 116 centers performed 1:1 allocation of 1115 patients with nonmetastatic PC to use an online decision aid (intervention = I) or a printed brochure (control = C). The primary outcome was treatment decision after 14 mo. The secondary endpoints were knowledge, acceptance, decisional conflict, physician-patient communication, anxiety and depression, decision regret, and quality of life.

Key findings and limitations: With complete data from 1000 patients, there was no difference between the two groups in terms of primary or secondary endpoints. In the intervention group, consultation time was shorter (I: 61 min vs C: 70 min, p = 0.02), and more patients provided a summary of their preparation (I: 76% vs C: 56%, p < 0.001). Life expectancy (I: 53% vs C: 47%, p = 0.03), radiotherapy (I: 90% vs C: 84%, p = 0.005), rehabilitation (I: 69% vs C: 62%, p = 0.02), and psycho-oncology (I: 21% vs C: 16%, p = 0.07) were discussed more frequently in the intervention group. Additionally, more counseling sessions with general practitioners (I: 43% vs C: 35%, p = 0.01) and radiotherapists (I: 24% vs C: 18%, p = 0.03) were held in the intervention group.

Conclusions and clinical implications: The use of the online decision aid was associated with structural improvements, for example, significantly shorter doctor-patient consultation time. Our findings suggest stronger guideline adherence in the counseling process and promotion of health literacy. Successful implementation of our online decision aid in routine care can provide an example for solving this key obstacle for shared decision-making.

Keywords: Decision aid; Health services research; Prostate cancer; Randomized controlled trial; Shared decision-making.

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Effects of a Patient Decision Aid for Nonmetastatic Prostate Cancer Established in Routine Care: The Randomized Controlled EvEnt-PCA Trial

Affiliations

Effects of a Patient Decision Aid for Nonmetastatic Prostate Cancer Established in Routine Care: The Randomized Controlled EvEnt-PCA Trial

Authors

Affiliations

Abstract

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