title: Evidence-based patient choice: a prostate cancer decision aid in plain language.
abstract: BACKGROUND
  Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer.
  
  
  METHODS
  Document development steps included preparing an evidence-based DA in standard medical parlance, iteratively translating it to emphasize shared decision making and plain language in three formats (booklet, Internet, and audio-tape). Scientific review of medical content was integrated with expert health literacy review of document structure and design. Formative evaluation methods included focus groups (n = 4) and survey of a new sample of men newly diagnosed with prostate cancer (n = 60), compared with historical controls (n = 184).
  
  
  RESULTS
  A transparent description of the development process and design elements is reported. Formative evaluation among newly diagnosed prostate cancer patients found the DA to be clear and useful in reaching a decision. Newly diagnosed patients reported more discussions with doctors about treatment options, and showed increases in knowledge of side effects of radiation therapy.
  
  
  CONCLUSIONS
  The plain language DA presenting medical evidence in text and numerical formats appears acceptable and useful in decision-making about localized prostate cancer treatment. Further testing should evaluate the impact of all three media on decisions made and quality of life in the survivorship period, especially among very low literacy men.
authors.affiliation: Department of Medicine, Michigan State University, C214 East Fee, East Lansing, MI, USA. mholmes@msu.edu
authors.forename: Margaret
authors.initials: M
authors.lastname: Holmes-Rovner
authors.forename: Sue
authors.initials: S
authors.lastname: Stableford
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Janet
authors.initials: J
authors.lastname: Ohene-Frempong
authors.forename: Karen
authors.initials: K
authors.lastname: Kelly-Blake
authors.forename: David R
authors.initials: DR
authors.lastname: Rovner
mesh_terms: D002755:Choice Behavior; D003661:Decision Support Techniques; D004522:Educational Status; D019317:Evidence-Based Medicine; D017144:Focus Groups; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007255:Information Services / Q000592:standards*; D020407:Internet; D008297:Male; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D010817:Physician-Patient Relations; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D014741:Video Recording