A multilevel intervention to improve adherence to prostate cancer active surveillance versus usual care: results from a pilot randomized controlled trial.
10 affiliations
- 1Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. [email protected].
- 2Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. [email protected].
- 3Department of Surgery, Urology Section, University of Chicago, Chicago, IL, USA.
- 4Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
- 5Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- 6Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
- 7Department of Urology, University of Michigan, Ann Arbor, MI, USA.
- 8Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
- 9Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- 10Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Abstract
Background
Active surveillance is the primary management strategy for men with low-risk prostate cancer and yet, adherence to active surveillance remains suboptimal. Men choose to receive surgery or radiation therapy even without any evidence of their cancer progressing or because of anxiety. Novel interventions to improve adherence are needed.Methods
We designed and implemented a pilot randomized clinical trial comparing usual care (control) versus a multilevel intervention (Management of Active surveillance in Prostate cancer [MAP] for patients with low-risk prostate cancer and their primary care providers (PCPs) between November 2022 and May 2023. Our primary outcomes were feasibility (defined by enrollment and survey completion rates) and acceptability (assessed by a participant satisfaction survey). Exploratory outcomes included additional surveys and interviews assessing patient- and PCP-reported measures. Eligible patients were adult men > 55 years old diagnosed with low-risk prostate cancer on active surveillance. Eligible PCPs were identified by enrolled patients. For the intervention arm, participants had access to a personalized website addressing barriers to adherence (knowledge, provider roles in team-based care delivery, managing cancer-related anxiety). PCPs of patients in the intervention arm received a templated visit summary from the urologist with the recommended active surveillance care plan.Results
Thirty-five patients were randomized and survey completion rate across both arms was 86%. Overall, 70% of intervention arm participants found MAP acceptable. Patients in the intervention arm (versus control) were more likely to prefer either PCP or urologist (versus urologist only) for various aspects of active surveillance care at 6-months. Other exploratory patient-reported outcomes were similar across arms.Conclusions
This study demonstrated a multilevel intervention (MAP) is feasible to deploy and acceptable. Importantly, MAP shows promise in building patient confidence about team-based active surveillance care delivery and increased primary care involvement through targeted education around the role or primary care.Trial registration
ClinicalTrials.gov identifier NCT05764005.
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BibTeX
@article{chen2026multilevel,
title = {{A multilevel intervention to improve adherence to prostate cancer active surveillance versus usual care: results from a pilot randomized controlled trial.}},
author = {Jason C Chen and Ted A Skolarus and Allison Furgal and Aaron Rankin and Lauren P Wallner and Tudor Borza and Sarah T Hawley and Archana Radhakrishnan},
journal = {BMC cancer},
year = {2026},
month = jul,
doi = {10.1186/s12885-026-16625-8},
url = {https://europepmc.org/article/MED/42963760},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A multilevel intervention to improve adherence to prostate cancer active surveillance versus usual care: results from a pilot randomized controlled trial.
AU - Jason C Chen
AU - Ted A Skolarus
AU - Allison Furgal
AU - Aaron Rankin
AU - Lauren P Wallner
AU - Tudor Borza
AU - Sarah T Hawley
AU - Archana Radhakrishnan
PY - 2026
DA - 2026/07/29
JO - BMC cancer
DO - 10.1186/s12885-026-16625-8
UR - https://europepmc.org/article/MED/42963760
AB - Background Active surveillance is the primary management strategy for men with low-risk prostate cancer and yet, adherence to active surveillance remains suboptimal. Men choose to receive surgery or radiation therapy even without any evidence of their cancer progressing or because of anxiety. Novel interventions to improve adherence are needed.Methods We designed and implemented a pilot randomized clinical trial comparing usual care (control) versus a multilevel intervention (Management of Active surveillance in Prostate cancer [MAP] for patients with low-risk prostate cancer and their primary care providers (PCPs) between November 2022 and May 2023. Our primary outcomes were feasibility (defined by enrollment and survey completion rates) and acceptability (assessed by a participant satisfaction survey). Exploratory outcomes included additional surveys and interviews assessing patient- and PCP-reported measures. Eligible patients were adult men > 55 years old diagnosed with low-risk prostate cancer on active surveillance. Eligible PCPs were identified by enrolled patients. For the intervention arm, participants had access to a personalized website addressing barriers to adherence (knowledge, provider roles in team-based care delivery, managing cancer-related anxiety). PCPs of patients in the intervention arm received a templated visit summary from the urologist with the recommended active surveillance care plan.Results Thirty-five patients were randomized and survey completion rate across both arms was 86%. Overall, 70% of intervention arm participants found MAP acceptable. Patients in the intervention arm (versus control) were more likely to prefer either PCP or urologist (versus urologist only) for various aspects of active surveillance care at 6-months. Other exploratory patient-reported outcomes were similar across arms.Conclusions This study demonstrated a multilevel intervention (MAP) is feasible to deploy and acceptable. Importantly, MAP shows promise in building patient confidence about team-based active surveillance care delivery and increased primary care involvement through targeted education around the role or primary care.Trial registration ClinicalTrials.gov identifier NCT05764005.
SN - 1471-2407
ER -