How patients' preferences for risk information influence treatment choice in a case of high risk and high therapeutic uncertainty: asymptomatic localized prostate cancer.
To assess how patients' preferences for non-numerical risk information are related to their tendency to choose early surgical treatment for asymptomatic gland-confined prostate cancer (a choice with high risk and high therapeutic uncertainty), the authors conducted a cross-sectional study of 228 patients receiving continuing care in a general medicine clinic. After being provided with three data disclosures related to the treatment decision, subjects were given a choice between surgery-now and watchful waiting. Data about surgical complications were presented in numerical format. The subjects were also asked whether they preferred communication with their physician about the chance (probability) of adverse outcomes-related to management strategies-in terms of words (such as possible or probable) or numbers (such as percentages). Of the 226 patients who chose either surgery-now or watchful waiting, 71.2% preferred risk information in terms of words only or numbers only: 44% words only, and 56% numbers only. Younger patients (OR = 1.06 per year; CI = 1.02-1.10, p = 0.0008) and those wanting risk communication in terms of words only (OR = 2.41; CI = 1.24-4.70, p = 0.01) tended to prefer surgery-now over watchful waiting as the management strategy for asymptomatic gland-confined prostate carcinoma. The authors conclude that there is a significant association between patients' preferences for risk communication with their physicians in terms of words only and a tendency to prefer early surgical intervention for prostate cancer when surgical risk data are provided numerically.
Mazur
D J
DJ
Medical Service and Health Services Research and Development Program, Department of Veterans Affairs Medical Center, Portland, Oregon 97201, USA.
Hickam
D H
DH
Mazur
M D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D006801:Humans; D007258:Informed Consent; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011183:Postoperative Complications; D011336:Probability; D011471:Prostatic Neoplasms / Q000145:classification / Q000601:surgery / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors