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 decisions.
Tools such as decision analyses that can easily incorporate the most recent research data, individual clinical characteristics, and patient preferences may facilitate decision making.