Impact of a Plain Language Prostate Cancer Decision Aid on Decision Making

  • Angela Fagerlin
  • Peter Ubel
  • Alexander SA
  • Holmes-Rovner M
  • Knight S
  • Ling B
  • Julie Tobi
  • Rosemarie Pitsch
Related Topics

 Approximately one in six men will be diagnosed with prostate cancer in their lifetime, and the vast majority of newly diagnosed prostate cancers are of early stage and low to moderate grade. Treatment options include radical prostatectomy, radiation, and watchful waiting. The treatment choices are very similar in terms of survival, but have different side effects, such as impotence or incontinence. Treatment for early stage prostate cancer can be considered a preference-sensitive decision, in that two or more treatment options can be considered medically justified, and the “right decision” depends upon the patient’s preferences. Every year hundreds of thousand men are confronted with this difficult decision. Unfortunately, this decision is even more difficult for men who have low literacy skills. Past research has shown that patients with limited literacy skills have poorer health outcomes for various conditions.

In this study, we will be testing a “plain language” decision aid about early stage prostate cancer and its treatments against a conventional decision aid at 4 VA health care systems. In addition to outcomes such as treatment choice, we will also examine the impact each decision aid has on patient-provider communication at the time of diagnosis. We will audio-record these conversations and analyze any differences in discussion of treatments (especially side effects) and shared decision making between the two decision aid groups. We will also examine the role of literacy in decision making and patient-physician communication. Finally, we want to explore reasons for differences in treatment preferences between African Americans and Caucasians.

VA Merit Award IIR 05-283-3