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Abstract: Objectives: Primary care providers often care for men with prostate cancer due to its prolonged clinical course and an increasing number of survivors. However, their attitudes and care patterns are inadequately studied. In this context, we surveyed primary care providers regarding the scope of their prostate cancer survivorship care. Methods: The 2006 Early Detection and Screening for Prostate Cancer Knowledge, Attitudes and Practice Survey conducted by the Michigan Public Health Institute investigated the beliefs and practice patterns of primary care providers in Michigan. We evaluated responses from 902 primary care providers regarding the timing and content of their prostate cancer survivorship care and relationships with specialty care. Results: Two-thirds (67.6%) of providers cared for men during and after prostate cancer treatment. Providers routinely inquired about incontinence, impotence and bowel problems (83.3%), with a few (14.2%) using surveys to measure symptoms. However, only a minority felt ‘very comfortable’ managing the side effects of prostate cancer treatment. Clear plans (76.1%) and details regarding management of treatment complications (65.2%) from treating specialists were suboptimal. Nearly one-half (45.1%) of providers felt it was equally appropriate for them and treating specialists to provide prostate cancer survivorship care. Conclusions: Primary care providers reported that prostate cancer survivorship care is prevalent in their practice, yet few felt very comfortable managing side effects of prostate cancer treatment. To improve quality of care, implementing prostate cancer survivorship care plans across specialties, or transferring primary responsibility to primary care providers through survivorship guidelines, should be considered. [Copyright &y& Elsevier]

Objective: To examine the feasibility of using automated interactive voice response calls to assess prostate cancer survivor quality of life (QOL). In light of an increasing focus on patient-centered outcomes, innovative and efficient approaches to monitor QOL among prostate cancer survivors are increasingly valuable. Methods: Forty prostate cancer survivors less than 1 year post-treatment were enrolled at a university-based cancer center clinic from July through August 2011. We adapted the Expanded Prostate Cancer Index Composite (EPIC) survey, a prostate cancer-specific QOL instrument, for use via personal telephone with interactive voice response. We compared written vs interactive voice response EPIC scores across urinary, sexual, bowel, and vitality domains. Results: The median age of respondents was 63 years (range, 41-76 years) and the majority had undergone surgery (97.5%). The entire interactive voice response call was completed by 35 participants (87.5%). Over half of all interactive voice response calls were answered after 2 attempts with a median length of 11.3 minutes. On average, interactive voice response EPIC scores were slightly lower than written scores (−2.1 bowel, P = .05; −4.6 urinary incontinence, P < .01). Test-retest reliability was very high for urinary incontinence (r = .97) and sexual function domains (r = .96). Although mean scores were similar for other domains, their distributions had significant ceiling effects limiting our reliability measure interpretation. Conclusion: Automated interactive voice response calls are a feasible strategy for assessing prostate cancer survivor QOL. Interactive voice response could provide a low cost, sustainable, and systematic approach to measuring patient-centered outcomes, conducting comparative effectiveness research, and monitoring the quality of prostate cancer care. [ABSTRACT FROM AUTHOR]

Objective: Develop a system of practice tools and procedures to prompt shared decision making in primary care. SDM-GRIP (Shared Decision Making Guidance Reminders in Practice) was developed for suspected stable coronary artery disease (CAD), prior to the percutaneous coronary intervention (PCI) decision. Methods: Program evaluation of SDM-GRIP components: Grand Rounds, provider training (communication skills and clinical evidence), decision aid (DA), patient group visit, encounter decision guide (EDG), SDM provider visit. Results: Participation – Physician training=73% (21/29); patient group visits=25% of patients with diagnosis of CAD contacted (43/168). SDM visits=16% (27/168). Among SDM visit pairs, 82% of responding providers reported using the EDG in SDM encounters. Patients valued the SDM-GRIP program, and wanted to discuss comparative effectiveness information with a cardiologist. SDM visits were routinely reimbursed. Conclusion: Program elements were well received and logistically feasible. However, recruitment to an extra educational group visit was low. Future implementation will move SDM-GRIP to the point of routine ordering of non-emergent stress tests to retain pre-decision timing of PCI and to improve coordination of care, with SDM tools available across primary care and cardiology. Practice implications: Guidance prompts and provider training appear feasible. Implementation at stress testing requires further investigation. [Copyright &y& Elsevier]

Objective: Analyze the role of collaboration in the International Shared Decision Making organization (ISDM). Methods: Case study of the seven year history of ISDM as a professional network. Results: The International Shared Decision Making meeting Conference (ISDM) has held four biennial meetings since its inception in 2001. It is a freestanding professional meeting, with no permanent institutional support and no formal governance structure. In both its history and its prospects, collaboration among attendees has been pivotal to its growth. It both attracts and holds its “members” through the strength of the relationships formed during and between meetings. Exchanges in ISDM are informational, collegial, and indirectly economic. Conclusion: ISDM's future rests on keeping all three functions healthy. It must maintain a focus on putting the shared decision making work first through becoming a “worknet”. Technologies that promote shared decision making can then be assembled and developed that support transformation of health care. Practice Implications: Innovative professional organizations need to develop their work through deliberate development of networking techniques to move innovation into practice. [Copyright &y& Elsevier]

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Abstract: Objective: As part of a study of men''s responses to a videotape decision aid [Rovner DR, Wills CE, Bonham V, Williams G, Lillie J, Kelly-Blake K, Williams MV, Holmes-Rovner M. Decision aids for benign prostatic hyperplasia: applicability across race and education. Med Decis Making 2004;24:359–66], preferences for BPH treatment options were assessed. Methods: One hundred and sixty men stratified by race and education completed a semi-structured interview that included assessments of treatment preferences. Results: Most men initially and ultimately favored watchful waiting over other options, and 56.6% never changed their preference rank orders while viewing the videotape. BPH severity in context of treatment risk avoidance, efficacy, and expert opinion factors were frequently cited reasons for preference orders. Lesser education was associated with higher likelihood of changing preferences (r =−.30, p <.001), and percent increase in BPH knowledge pre- to post-videotape was weakly associated with fewer non-dominant preference shifts (r =−.19, p <.05). Conclusion: Conservatism regarding BPH treatment is moderated by context-specific factors, including new information. Practice implication: Counseling in a provider–patient partnership model should address both sources of variance in men''s treatment preferences. [Copyright &y& Elsevier]

The objective of this project was to analyze newspaper coverage of the January 2000 meta-analysis by Gotzsche and Olsen, “Is screening for breast cancer with mammography justified?” [Lancet 355 (2000) 129]. A content analysis was performed on a comprehensive set of newspaper clippings from the UK during the 2 weeks following publication of the Lancet article. The original authors were most quoted in Wave 1 (the first weekend); the screening programme was most quoted in Wave 2 (week 2). Screening programme description, and the “quality” of the Lancet article dominated Wave 1; patient testimonials increased in Wave 2. Newspaper articles were structured as debates between experts and advocates, thereby enhancing polarisation of opinion. We suggest this is counter-productive to evidence-based patient choice and public involvement in decision-making. Medical journals’ and charities’ press releases that begin to include discussion of uncertainty inherent in medical technologies can contribute to evidence-based public deliberation. [Copyright &y& Elsevier]

How does the way that information is presented potentially influence patients’ consent for health treatments, in a shared decision making process? The goal of this paper is to present an overview of selected recent literature concerning patient health information presentation/use for treatment decision making. Recent work with patient populations has begun to extend early cognitive psychological work showing systematic biases in thinking. Key research findings are organized by type of format (probability, graphic, and qualitative/quantitative dimensions). The applied literature on this topic is amenable to only limited integration in regard to key findings, and relatively few novel approaches to improving information comprehension have been described in the health literature. Promising approaches being proposed, developed, and tested are described, such as enhanced-access computerized patient choice modules, “debiasing” techniques, and tailoring of information. Additional theoretical and practical issues are discussed, as well as selected policy implications of current knowledge. [Copyright &y& Elsevier]

Objectives: This paper describes the development and pilot testing of a communication skills curriculum based on medical student curriculum and modified for use with patients. Methods: Six key concepts from our introductory medical education communication skills curriculum were identified. The core knowledge and skills related to these concepts were reorganized into six modules, including presentation materials, handouts and active learning components. The curriculum was pilot tested with three independent groups of non-medical participants, representing a broad cross-section of the community. Results: Participants reported a high level of satisfaction; over 80% found the program helpful for learning new information and skills, and 92% for working with their physicians. Over 90% would recommend the program to others. Participant self-assessments revealed the greatest change in knowledge of medical interviewing. Skill changes were greatest in expressing emotion and efficiently telling the medical story. The pilot tests also highlighted the importance of other issues related to recruitment and health literacy. Conclusions: This project demonstrates that key concepts underlying doctor–patient communications can be simplified and repackaged for use from the patient's perspective. Practice implications: Similar curricula can empower patients from all walks of life to better communicate with their health care providers and enhance their healthcare experience. [Copyright &y& Elsevier]

Objective: To determine whether racial differences exist in patient preferences for prostate cancer treatment after being informed about options using a patient-centered vs. a standard decision aid (DA).Methods: This article reports secondary analyses of a large study of men diagnosed with early stage prostate cancer. Men were recruited from 4 VA Health Systems and randomized to receive a patient-centered or standard DA about prostate cancer treatment options. Data were collected at 1) baseline, 2) after reading the DA but prior to diagnosis, and 3) after receiving a cancer diagnosis and meeting with a urologist.Results: White patients who received the patient-centered DA written at a 7th grade reading level were more likely to prefer active surveillance and less likely to prefer radiation compared to those who received the standard DA written at >9th grade reading level. African American patients' treatment preferences did not differ as a function of DA.Conclusions: When informed about prostate cancer treatment options through a patient-centered DA, White patients changed their treatment preferences but African American patients did not.Practice Implications: As DAs are increasingly being used in clinical practice, more research is needed regarding the efficacy, relevance, and receptivity of DAs for African Americans. [ABSTRACT FROM AUTHOR]

Abstract: Objective: With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school. Methods: 533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school. Results: Fourth-year students were slightly more pessimistic about patients’ understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p =0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences. Conclusion: Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients’ understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients’ understanding or from desensitization to jargon during medical school. Practice implications: Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula. [Copyright &y& Elsevier]

Some instruments have been developed to evaluate 'decision effectiveness' such as the 'satisfaction with decision (SWD)' and 'decision conflict (DCS)' scales and are validated for the US context. Patients identify further outcome domains that are not fully covered in these scales. We developed a patient-based outcome measure to evaluate risk communication and decision making effectiveness, addressing these further domains and validated for use in the UK. Formulation of items was based on literature review and key informant interviews. The instrument was piloted and developed (including psychometric assessment) in the context of a trial of decision making and risk communication interventions in general practice. Patients were recruited to the trial with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms. High response rates (96% in first phase) indicated acceptability to patients. A 20 item patient-based outcome measure, with two sub-scales for 'risk communication' and 'confidence in decision', was produced. It allows for paternalistic, shared or informed choice decision making models. Usage in further studies will facilitate systematic reviews. Consequently, lessons for wider application of these interventions in practice, and policy implications regarding greater patient involvement should then be clearer. [ABSTRACT FROM AUTHOR]