Abstract:
Purpose To study the cognitive processes of early-stage prostate
cancer patients as they determined which treatment they preferred,
using our cognitively based decision aid.
Method The aid was a one-to-one interview that included the
structured presentation of information, listing exercises in which the
patient identified attributes important to his decision, and trade-off
exercises to help him weigh and integrate those attributes together.
At various points of the interview, patients identified the attributes
they felt were important to their decision, rated their treatment
options and completed standardized assessments relating to their
decision. In addition, patients participated in a follow-up interview
at the time they made their actual treatment decision and again
3 months later.
Results Sixty of 70 (86%) of the invited patients participated in the
study. Participating patients identified a median of four important
attributes (range 1–10); 36 different attributes were identified at
some point in the interview by the group. During the interview, 78%
of patients changed which attributes they considered important, and
72% changed their treatment ratings. Stability of treatment choice
after the interview and lack of regret after the decision were each
positively associated with increasing differentiation between treatment
options over time.
Conclusions The decision process appears to be dynamic for the
patients with great variability across patients in what is important
to the decision. Increasing stability of choice and lack of regret
appear to be related positively to increasing difference over time
in how attractive the preferred option is over its closest
competitor, rather than to the size of the difference at any one
point in time.