How Patients' Preferences for Risk Information Influence Treatment Choice in a Case of High Risk and High Therapeutic Uncertainty

Abstract

To assess how patients' preferences for non-numerical risk information are related to their tendency to choose early surgical treatment for asymptomatic gland-confined prostate cancer (a choice with high risk and high therapeutic uncertainty), the authors conducted a cross-sectional study of 228 patients receiving continuing care in a gen eral medicine clinic. After being provided with three data disclosures related to the treatment decision, subjects were given a choice between surgery-now and watchful waiting. Data about surgical complications were presented in numerical format. The subjects were also asked whether they preferred communication with their physician about the chance (probability) of adverse outcomes—related to management strate gies—in terms of words (such as possible or probable) or numbers (such as percent ages). Of the 226 patients who chose either surgery-now or watchful waiting, 71.2% preferred risk information in terms of words only or numbers only: 44% words only, and 56% numbers only. Younger patients (OR = 1.06 per year; Cl = 1.02-1.10, p = 0.0008) and those wanting risk communication in terms of words only (OR = 2.41; Cl = 1.24-4.70, p = 0.01) tended to prefer surgery-now over watchful waiting as the management strategy for asymptomatic gland-confined prostate carcinoma. The au thors conclude that there is a significant association between patients' preferences for risk communication with their physicians in terms of words only and a tendency to prefer early surgical intervention for prostate cancer when surgical risk data are pro vided numerically. Key words: informed consent; medical decision making; patient- physician communication; patient preference; prostate carcinoma; nsk. (Med Decis Making 1999;19:394-398)