Prostate Stay Tuned: A Type 2 Hybrid Study for the Development and Implementation of a Nurse-Guided Decision Support Program in Low-Risk Prostate Cancer

Abstract

Introduction. Prostate cancer is the most commonly diagnosed malignancy in men. The widespread use of PSA testing has increased the detection of low-risk localised tumours, but has also contributed to overdiagnosis and overtreatment. Although active surveillance is recommended as the preferred initial option, its uptake remains uneven. In the Lazio region, contextual analysis identified multilevel barriers: at the macro level, fragmented policies and uneven implementation of Community Health Houses; at the meso level, only 25% of centers had standardized active surveillance workflows and only 2 of 8 hospitals used electronic shared decision-making tools; at the micro level, 52% of men with prostate cancer had limited health literacy and 78% of patients on active surveillance reported anxiety related to “untreated cancer.” These findings indicate a significant implementation gap. The aim of this study was to develop, implement, and evaluate Prostate Stay Tuned, a regional nurse-guided decision support program for men with low-risk localised prostate cancer, aimed at reducing inappropriate opportunistic PSA testing and overtreatment.

Methods. This is a hybrid type 2 effectiveness implementation study. The project integrates a realist review, contextual analysis, and stakeholder co-design. The Ottawa Decision Support Framework will guide the identification of decisional needs, decisional conflict, and values clarification; Festinger’s cognitive dissonance theory will support the interpretation of the psychological mechanisms that hinder acceptance of active surveillance. The intervention will include a nurse trained in decision coaching, an evidence-based decision aid, a structured care pathway, multiprofessional integration, ongoing training, and audit and feedback.

Results. The project is currently in development; available findings derive from the contextual analysis, which indicates low implementation readiness and identifies the main challenges as weak pathway standardisation, limited infrastructure for decision support, and the high emotional burden associated with active surveillance.

Discussion. Prostate Stay Tuned frames low-risk prostate cancer as both a clinical and an organisational challenge. For nursing practice, the project may strengthen decision coaching as an advanced competence and support a model that is both applicable and sustainable. The next phases will examine implementation, adherence, and long-term sustainability.