Men who are uneducated about their prostate cancer have difficulty making treatment decisions

They say knowledge is power, and a new study has shown this is definitely the case when it comes to men making the best decisions about how to treat their prostate cancer. Researchers found that men who are not well educated about their disease have a much more difficult time making treatment decisions, called decisional conflict. This challenge could negatively impact the quality of their care and their long-term outcomes.

The study should serve as a wake-up call for clinicians who can use the findings to target men less likely to know a lot about their prostate cancer and provide educational materials prior to their appointments so they are more comfortable making treatment decisions, said study first author Alan Kaplan, MD, a resident physician in the University of California Los Angeles (UCLA) Department of Urology. The findings from the 1-year study were published in Cancer (2014; doi:10.1002/cncr.28755).

"For prostate cancer, there is no one right answer when it comes to treatment. It comes down to the right answer for each specific patient, and that is heavily dependent on their own personal preferences," Kaplan said. "Men in general, and specifically economically disadvantaged men, have a hard time deciding what their preferences are, how they feel about any possible complications, and what the future after treatment might be like. If you don't know anything about your disease, you'll have a really tough time making a decision."

The research team surveyed 70 men at a Veterans Administration clinic with newly diagnosed localized prostate cancer and who had enrolled in a randomized trial testing a novel shared decision-making tool. The team collected baseline demographic and clinical information such as age, race, education, co-existing medical conditions, relationship status, urinary and sexual dysfunction, and their prostate cancer knowledge.

UCLA researchers talked one-on-one with the men after they had received their cancer diagnosis, but before they consulted with a physician. Median age of the men in the study was 63 years, 49% were African American, and 70% reported an annual income of less than $30,000.

Kaplan said the team found that a low level of prostate cancer knowledge was associated with increased decisional conflict and higher uncertainty about what treatment to choose. Low levels of prostate cancer knowledge also were associated with lower perceived effectiveness, which meant that the less they knew about their cancer, the less confidence they had that the treatment would be effective.

"Knowledge about prostate cancer is an identifiable target. Interventions designed to increase a patient's comprehension of prostate cancer and its treatments may greatly reduce decisional conflict," Kaplan said, adding that further study is needed to better characterize this relationship and identify effective targeted interventions.

Another benefit to reducing decisional conflict is that patients who feel comfortable with their decision may have regret their decisions less down the line, Kaplan said. They are less likely to sue their doctors and generally experience better outcomes.

Kaplan said economically disadvantaged men may be having more difficulty because they may not have as much experience negotiating the health care system and are less confident when communicating with doctors.

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