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Concordance of Couples’ Prostate Cancer Screening Recommendations from a Decision Analysis

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Abstract

Objective: To determine whether different utilities for prostate cancer screening outcomes for couples, and husbands and wives separately, lead to incongruent screening recommendations.

Methods: We evaluated survey results of 168 married couples from three family practice centers in Texas, USA. Utilities for eight adverse outcomes of prostate cancer screening and treatment were assessed using the time trade-off method. We assessed utilities separately for each partner and jointly for each couple. Using a previously published decision-analytic model of prostate cancer screening, we input the husband’s age (starting point) and utilities for outcomes from the husband’s, wife’s, and couple’s perspectives (to adjust for quality of life). Both group-level and individualized models were run. We also asked husbands (and wives) if they intended to be screened (or have their husbands screened) for prostate cancer in the future.

Results: Husbands’ lower tolerance for adverse outcomes (lower utilities) was associated with lower quality-adjusted life expectancy (than their wives) for the choice of screening versus not screening. Depending on the perspective, 48 husbands (28.6%), 89 wives (53.0%), and 58 couples (34.5%) preferred screening in the individual decision-analytic models. Comparing the three perspectives, agreement in model recommendations was greatest between the husbands and the couples (82.1%), intermediate between the wives and couples (63.7%), and lowest between the husbands and wives (55.4%). Using group-aggregated utilities in the decision-analytic model tended to mask the variation in recommended strategies amongst individuals. There was no relationship between screening preferences from the model and the husbands’ and wives’ reported desire for screening, as the majority of subjects wanted screening.

Conclusions: Discordant health preferences may yield conflicting recommendations for prostate cancer screening. The results have broad implications for informed healthcare decision making for couples.

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Acknowledgements

This study was supported by a grant (R01 HS08992) from the Agency for Healthcare Research and Quality (Rockville, MD, USA). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report. The authors have no conflicts of interest that are directly relevant to the content of this study.

The authors thank Walter J. Pagel, ELS(D), LeeAnn Chastain, Charissa Higginbotham, and Pamela P. Metoyer, ELS(D) for their editorial contributions, which enhanced the clarity of the manuscript.

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Authors and Affiliations

  1. Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Unit 447, 1515 Holcombe Blvd, Houston, Texas, 77030-4009, USA

    Scott B. Cantor & Jawaria Gilani

  2. Department of Family and Community Medicine, Baylor College of Medicine and Houston Center for Education and Research on Therapeutics, Houston, Texas, USA

    Robert J. Volk & Stephen J. Spann

  3. Division of Clinical Decision-Making & Health Care, Toronto General Research Institute, Toronto, Ontario, Canada

    Murray D. Krahn

  4. Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA

    Alvah R. Cass

  5. Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA

    Susan C. Weller

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  1. Scott B. Cantor
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Correspondence to Scott B. Cantor.

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Cantor, S.B., Volk, R.J., Krahn, M.D. et al. Concordance of Couples’ Prostate Cancer Screening Recommendations from a Decision Analysis. Patient-Patient-Centered-Outcome-Res 1, 11–19 (2008). https://doi.org/10.2165/01312067-200801010-00004

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