title: Offering a treatment choice in the irradiation of prostate cancer leads to better informed and more active patients, without harm to well-being.
abstract: OBJECTIVE
  To examine, in prostate cancer patients, the effect of (1) being offered a choice between radiation doses in three-dimensional conformal radiotherapy, and of (2) accepting or declining the possibility to choose.
  
  
  METHODS
  A total of 150 patients with localized prostate cancer (T1-3N0M0) were offered a choice with a decision aid between two radiation doses (70 and 74 Gy). A control group of 144 patients received a fixed radiation dose without being offered a choice. Data were collected at baseline (before choice), before treatment (after choice), and 2 weeks and 6 months after treatment completion.
  
  
  RESULTS
  Compared with the control group, the involvement group, receiving the decision aid, showed increased participation in decision making (p < 0.001), increased knowledge (p < 0.001), and improved risk perception (p < 0.001); they were more satisfied with the quality of information (p = 0.002) and considered their treatment a more appropriate treatment (p = 0.01). No group differences were found in well-being (e.g., general health, European Organization for Research and Treatment of Cancer quality of life, anxiety). Within the involvement group, accepting or declining the option to choose did not affect well-being either.
  
  
  CONCLUSIONS
  Offering a choice of radiation dose, with a decision aid, increased involvement in decision making and led to a better-informed patient. In contrast to earlier suggestions, a strong increase in involvement did not result in improved well-being; and in contrast to clinical concerns, well-being was not negatively affected either, not even in those patients who preferred to leave the decision to their physician. This study shows that older patients, such as prostate cancer patients, can be informed and involved in decision making.
authors.affiliation: Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. J.vanTol@rther.umcn.nl
authors.forename: Julia J
authors.initials: JJ
authors.lastname: van Tol-Geerdink
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Leer
authors.forename: Emile N J Th
authors.initials: EN
authors.lastname: van Lin
authors.forename: Erik C
authors.initials: EC
authors.lastname: Schimmel
authors.forename: Henk
authors.initials: H
authors.lastname: Huizenga
authors.forename: Willem A J
authors.initials: WA
authors.lastname: van Daal
authors.forename: Peep F M
authors.initials: PF
authors.lastname: Stalmeier
mesh_terms: D000368:Aged; D000465:Algorithms; D016022:Case-Control Studies; D002755:Choice Behavior; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D010358:Patient Participation; D010549:Personal Satisfaction; D011471:Prostatic Neoplasms / Q000523:psychology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal