Prostate cancer: how do patients choose their treatment?
ABSTRACT Prostate cancer remains a public health concern in France for men between 50 and 70 years old. Low-risk or intermediate-risk localised prostate cancer can be treated by a number of therapeutic options. Objective. Identify, in patients' discourse, the mechanisms and the logic involved in therapeutic decision-making. Method. Qualitative study involving 15 men aged between 53 and 70 years, treated for early-stage prostate cancer, via interviews examining diagnosis pathway, how patients perceive and cope with the illness, and how they choose a treatment. Results. The men made their choices using their own initiative during a multiple-stage process. The determining factors were: quality of relationship with physicians, wish to benefit from the available technological advances in medical care, and minimum impairment to their sexual and reproductive identity. Chances of survival did not appear to be their primary concern. Conclusion. This qualitative study reveals that men make their own decisions in terms of choice of therapy, whether encouraged by their physicians to participate or not.
Article: Shared decision-making in question[Show abstract] [Hide abstract]
ABSTRACT: Over recent years, communication within the physician-patient relationship has been profoundly changing. New modes of conveying diagnostic and therapeutic information influence the way in which decisions regarding treatment are made. We propose a critical review of the various theoretical models as presented in the literature, from the paternalistic to the shared decision model, in order to reveal conceptual ambiguities and their related methodological problems. This analysis leads to a project for clarifying these problems through a research protocol based on shared decision-making.Psycho-Oncology 03/2001; 10(2):93-102. DOI:10.1002/pon.502 · 4.04 Impact Factor
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ABSTRACT: Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants--physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.Social Science & Medicine 03/1997; 44(5):681-692. DOI:10.1016/S0277-9536(96)00221-3 · 2.56 Impact Factor
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ABSTRACT: The aim of this study is to help patients with breast cancer express their preferences concerning adjuvant chemotherapy and to observe how they perceive and experience the information and the situation of choice. Ten women with breast cancer without axillary extension were observed. We choose to use the decision board method, which consists of both a printed interview guide and a visual aid, designed to inform patients as objectively as possible, to help them choose between two options, chemotherapy or no chemotherapy. Based on interviews with patients we investigated how the patients perceive information given and the situation of choice with which they have been confronted. The results of this study show how patients reached their decision and what factors intervene in the decision process. This study underlies the difficulties of the health care decision process and shows how the patients react when faced with the information and the choice. The most interesting observation is that patients don’t make a rational choice according to the information given by the decision board, but mainly make an irrational choice based on the interpretation of the physician’s intent.Annales Médico-psychologiques revue psychiatrique 05/2002; 160(4):289-302. DOI:10.1016/S0003-4487(02)00171-3 · 0.15 Impact Factor