title: What Is a "Good" Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer.
abstract: We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision.
  
  
  
  Men with newly diagnosed clinically localized prostate cancer (N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed at 6 months after treatment.
  
  
  
  More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment.
  
  
  
  Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects.
authors.affiliation: Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
authors.forename: Heather
authors.initials: H
authors.lastname: Orom
authors.affiliation: Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
authors.forename: Caitlin
authors.initials: C
authors.lastname: Biddle
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA (WU)
authors.forename: Willie
authors.initials: W
authors.lastname: Underwood
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA (CJN)
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Nelson
authors.affiliation: Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
authors.forename: D Lynn
authors.initials: DL
authors.lastname: Homish
mesh_terms: D000368:Aged; D003657:Decision Making; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life
keywords: cohort studies; detailed methodology: QOL in special populations; patient decision making; prostate cancer