Intervention Arm (Healium)
urinary or sexual dysfunction, prostate cancer
DISEASE, PROSTATE CANCER
Participants assigned to the intervention arm completed the Healium program on a provided laptop computer in an internet-enabled clinic room. A member of the study team remained in the room to assist with technical questions but did not answer any disease or treatment-related questions. On average, it took participants 10-13 minutes to complete Healium.Healium is a web-based platform that employs a user-centric design and aims to appeal to a low-health literate population. It features a simple language and layout, a large font size, contrasting text and background colors, a bright color palette, and the use of short labels and headings to describe content.Healium uses plain language and easy-to-use touchscreen commands for navigation. To minimize cognitive load during decision-making, complex treatment decision-making is broken down into a series of simple gate questions that are answered in a yes or no format. The program begins by eliciting users’ preferences on whether they want to treat their prostate cancer immediately or whether they want to wait. In other words, the program offers the choice between active surveillance or active treatment (ie, surgery or radiation). If a patient chooses active surveillance, the next page contains 4 to 5 preferences (eg, side-effects or treatment features) characteristic of the selected choice. Touch or mouse controls are used to move a slider across the screen, to indicate whether the patient would be “bothered” by the selected feature (ie, range from “not at all,” to “somewhat” to “bothered a great deal”). The higher the level of “bother” the larger the corresponding-colored circle grows. The circle size serves as a visual representation of the patients’ preferences in that specific area. Once all preferences are rated and submitted, the program generates a summary report, with the different colored and sized circles included. If the patient endorses that certain symptoms associated with a particular treatment are highly bothersome (eg, no tolerance for potential urinary or sexual dysfunction), the program suggests that this particular treatment choice is not compatible with the stated preferences. The user is then prompted to revisit the prior preference rating page or to “start over” again, such as exploring a different treatment modality (eg, radiation therapy). Such an iterative process of preference elicitation and evaluation mimics a natural decision process: As patients are presented with different considerations that they are asked to rate, they might be exposed to new, important information, that might influence their treatment choice. Users are encouraged to continue to explore the tool and discuss the treatment preference summary generated by the program with their physicians.Although not the focus of this manuscript, the development of Healium was guided by the ORBIT (Obesity-Related Behavioral Intervention Trials) model [