With no clearly
superior treatment for localized prostate cancer, physicians and patients would
like to increase patient participation in the decision-making process.
Unfortunately, physicians frequently have difficulty understanding patients’
preferences, and patients often do not have sufficient knowledge to make an
informed treatment decision. Shared- decision-making tools, such as decision
analyses, may increase patient participation and thereby improve physicians’
understanding of their patients’ views.
Different ideas about the objectives of treatment and
miscommunication about treatment issues often characterize patient-physician
interactions. In a survey of prostate cancer patients, Crawford demonstrated
that patients and physicians differ in what they believe should be the goals of
treatment. While patients viewed preservation of quality of life and extension
of life as the most important treatment goals, urologists focused on treatment
effectiveness as the most important consideration.
Patients and physicians also differed in their descriptions
of the patient-physician encounter. Only one fifth of patients remembered
having discussed their preferences, the costs of treatment, and the side
effects of prostate cancer and its treatment with their physician. In
comparison, all urologists queried recalled discussing these issues, including
alternative treatment options.
In another study of patient-physician interactions,
physicians could not specify their patients’ concerns, even when patients
remembered that their doctor asked for this information.
These studies suggest that physician understanding of
patient preferences and patient participation in treatment decision making need
to be addressed.
Shared-decision-making tools, including CD-ROMs, videotapes,
brochures, and decision analyses, can educate patients and can aid doctors in
understanding patients’ preferences and including them in the decision-making
process. Unfortunately, many of these tools require constant updates of the
material presented, apply group-level recommendations to individual patients,
and do not educate patients well enough to allow them to make informed
Tools such as decision analyses that can easily incorporate
the most recent research data, individual clinical characteristics, and patient
preferences may facilitate decision making.
1. Crawford DE et al: Comparison of perspectives on prostate
cancer: Analysis of survey data. Urology 50:336, 1997.
2. Knight SJ et al: Perceived involvement with care, patient
satisfaction, and patient-clinician agreement about prostate cancer utilities.
ASCO 35th Annual Meeting, Atlanta, 1999, abstract 1589.
3. Kaplan S: The future of patient input into medical
decision making (editorial). Quality Review Bulletin 18:182, 1992.
4. Kattan MW et al: A decision analysis for treatment of
clinically localized prostate cancer. J Gen Intern Med 12: 299, 1997.
5. Beck JR et al: A critique of the decision analysis for clinically
localized prostate cancer. J Urol 152:1894, 1994.