Michigan
Promoting Shared Decision Making Among Prostate Cancer Patients
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Public Health Problem
Among men living in Michigan, prostate cancer is the most commonly diagnosed form of noncutaneous cancer and the second leading cause of cancer mortality, accounting for 3% of deaths overall and 5% of deaths among African American men. Because standard treatments of early disease have not demonstrated a decrease in disease-specific mortality and often result in significant side effects�impotence, urinary incontinence, and bowel incontinence�this is an area in which the shared decision making (SDM) model should be used to decide which treatment to pursue.
SDM is consistent with the ethical principle of autonomy. The more an individual is involved in making decisions, the greater is the likelihood that the decisions reflect the individual's needs, preferences, and values. Increased patient participation in health care can improve patient adherence to a chosen course of action and, therefore, health outcome. SDM interventions also increase patient access to accurate and balanced information.
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Program Example
A survey of prostate cancer patients found that men did not have adequate knowledge about prostate cancer and its treatments, especially African American men and less educated men. A review of patient educational materials (PEMs) for existing prostate cancer treatment also showed that although the majority of materials contained basic information, there is room for improvement in the following areas: inclusion of statistical information and more realistic presentation.
Making the Choice: Deciding What to Do About Early Stage Prostate Cancer is a publication that describes the risks and benefits associated with prostate cancer treatments, has a lower readability level, and was produced with individuals with low literacy. This tool informs the patient on the disease process, lab results, and treatment options with resulting outcomes and side effects and encourages the treatment decision to be consistent with the man�s personal values and preferences. Individuals, health organizations, and other interested entities can now order the materials at no charge. As of June 2004, 6,676 of the booklets and 677 of the audio sets had been ordered.
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Implication and Impact
A total of 60 surveys, 20 for each format of the PEM, were conducted to determine patient knowledge and understanding. Preliminary analysis suggests a need for greater understanding, especially about the age factor in a decision regarding watchful waiting and the slower growth rate in general for prostate cancer. Further evaluation will determine whether the PEM affected decision making.
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Contact Information
Cancer Prevention*
Cancer Prevention and Control Section
Michigan Department of Community Health
Washington Square Building, 5th Floor
109 Michigan Avenue
PO Box 30195
Lansing,
MI 48909
(517) 335-9620
Fax: (517) 335-9397
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