How Should Decision Aids Be Developed and Which Patient Outcomes Should Be Assessed? Comments on Tilburt et al

Details

• Journal Article:
  Cancer
• Personal Author:
  Diefenbach, Michael A. ; Miller, Suzanne M.
• Description:
  We have read with great interest the recent article by Tilburt et al published in Cancer. The article describes the results of a small, multicenter, cluster randomized controlled trial during which 21 urology practices affiliated with National Cancer Institute Community Oncology Research Program sites were randomized to implement 2 different types of decision aids-before the clinical visit (ie, a previsit decision aid), during the clinical visit (a within-visit decision aid), or at both times (ie, before and during)-or usual care. The results showed that the investigators succeeded in recruiting a large proportion of minority men into the study from urological practices. This is an important achievement because prostate cancer is usually diagnosed in community settings, but most research is being conducted in regional cancer centers. Thus, the ability to conduct a trial successfully in the community setting is an important contribution. We are not surprised by the null result of prostate cancer knowledge. Tilburt et al note that in past research, knowledge has not been notably associated with the use of decision aids; hence, the decision to focus on knowledge as the primary outcome is puzzling. Knowledge has played an outsized role in the judgment and decision-making literature, which has been driven by the common belief that a patient needs to be informed to make a medical decision. We are not arguing with this core assumption; however, we ask investigators to think about what "being informed" really means for individual patients. It has been well established that patients' approaches to decision-making do not necessarily follow a rational model. Instead, patient' understanding and decisions are influenced by beliefs and expectations, swayed by affect, and guided by opinions from experts and nonexperts alike. When asked, patients generally agree that they feel informed. However, given these myriads of influences, knowledge as a measure of decision-making is clearly suboptimal. [Description provided by NIOSH]
• Subjects:
  Decision Making Decision Support Techniques Men Minority Health Neoplasms Occupational Health Patient Participation Risk Assessment Risk Factors Safety
• Keywords:
  Urogenital system disorders; Minority health; Humans; Men; Prostate cancer; Cancer; Communication systems; Risk factors; Risk assessment; Treatment
• Source:
  Cancer 2022 Aug; 128(15):2988-2989
• ISSN:
  2072-6694
• Pubmed ID:
  35507272
• Pubmed Central ID:
  PMC9262809
• Document Type:
  Text
• Funding:
  R01 CA224918/CA/NCI NIH HHSUnited States/ ; U01 OH011690/OH/NIOSH CDC HHSUnited States/ ; U01OH011690/ACL/ACL HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2 ; OSHA Region 3 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  2 pdf pages
• Volume:
  128
• Issue:
  15
• NIOSHTIC Number:
  nn:20065792
• Email:
  Mdiefenbach@northwell.edu
• Federal Fiscal Year:
  2022
• Performing Organization:
  Feinstein Institute for Medical Research, New York
• Peer Reviewed:
  False
• Collection(s):
  National Institute for Occupational Safety and Health CDC Public Access
• Main Document Checksum:
  urn:sha-512:7e22920aa12d5ec2be2e223a93fd0c47f42e7bbd62bc327ddbe79a4fcb365b2d334743f62de5f9ecbd60a6a6820073f05a4a3675ac446da4e30c0a3689602219
• Download URL:
  https://stacks.cdc.gov/view/cdc/119360/cdc_119360_DS1.pdf
• File Type:
  [PDF - 32.21 KB ]