title: Decisional conflict in economically disadvantaged men with newly diagnosed prostate cancer: baseline results from a shared decision-making trial.
abstract: BACKGROUND
  Decisional conflict is a source of anxiety and stress for men diagnosed with prostate cancer given uncertainty surrounding myriad treatment options. Few data exist to help clinicians identify which patients are at risk for decisional conflict. The purpose of this study was to examine factors associated with decisional conflict in economically disadvantaged men diagnosed with prostate cancer before any treatment choices were made.
  
  
  METHODS
  A total of 70 men were surveyed at a Veterans Administration clinic with newly diagnosed localized prostate cancer enrolled in a randomized trial testing a novel shared decision-making tool. Baseline demographic, clinical, and functional data were collected. Independent variables included age, race, education, comorbidity, relationship status, urinary/sexual dysfunction, and prostate cancer knowledge. Tested outcomes were Decisional Conflict Scale, Uncertainty Subscale, and Perceived Effectiveness Subscale. Multiple linear regression modeling was used to identify factors associated with decisional conflict.
  
  
  RESULTS
  Mean age was 63 years, 49% were African American, and 70% reported an income less than $30,000. Poor prostate cancer knowledge was associated with increased decisional conflict and higher uncertainty (P < .001 and P = 0.001, respectively). Poor knowledge was also associated with lower perceived effectiveness (P = 0.003) whereas being in a relationship was associated with higher decisional conflict (P = 0.03).
  
  
  CONCLUSIONS
  Decreased patient knowledge about prostate cancer is associated with increased decisional conflict and lower perceived effective decision-making. Interventions to increase comprehension of prostate cancer and its treatments may reduce decisional conflict. Further work is needed to better characterize this relationship and identify effective targeted interventions.
authors.affiliation: Department of Urology, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Kaplan
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Crespi
authors.forename: Josemanuel D
authors.initials: JD
authors.lastname: Saucedo
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Connor
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000368:Aged; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D034462:Dissent and Disputes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D035862:Vulnerable Populations
keywords: decisional conflict; knowledge; low socioeconomic status; patient education; prostate cancer