title: Patient-focussed decision-making in early-stage prostate cancer: insights from a cognitively based decision aid.
abstract: OBJECTIVE
  To study the cognitive processes of early-stage prostate cancer patients as they determined which treatment they preferred, using our cognitively based decision aid.
  
  
  METHODS
  The aid was a one-to-one interview that included the structured presentation of information, listing exercises in which the patient identified attributes important to his decision, and trade-off exercises to help him weigh and integrate those attributes together. At various points of the interview, patients identified the attributes they felt were important to their decision, rated their treatment options and completed standardized assessments relating to their decision. In addition, patients participated in a follow-up interview at the time they made their actual treatment decision and again 3 months later.
  
  
  RESULTS
  Sixty of 70 (86%) of the invited patients participated in the study. Participating patients identified a median of four important attributes (range 1-10); 36 different attributes were identified at some point in the interview by the group. During the interview, 78% of patients changed which attributes they considered important, and 72% changed their treatment ratings. Stability of treatment choice after the interview and lack of regret after the decision were each positively associated with increasing differentiation between treatment options over time.
  
  
  CONCLUSIONS
  The decision process appears to be dynamic for the patients with great variability across patients in what is important to the decision. Increasing stability of choice and lack of regret appear to be related positively to increasing difference over time in how attractive the preferred option is over its closest competitor, rather than to the size of the difference at any one point in time.
authors.affiliation: Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada. deb.feldman-stewart@krcc.on.ca
authors.forename: Deb
authors.initials: D
authors.lastname: Feldman-Stewart
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brundage
authors.forename: Lori
authors.initials: L
authors.lastname: Van Manen
authors.forename: Ola
authors.initials: O
authors.lastname: Svenson
mesh_terms: D002170:Canada; D003071:Cognition; D003661:Decision Support Techniques; D042241:Early Diagnosis; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D018802:Patient-Centered Care; D011471:Prostatic Neoplasms / Q000523:psychology / Q000628:therapy*