PATIENT REACTIONS TO A PROGRAM DESIGNED TO FACILITATE PATIENT PARTICIPATION IN TREATMENT DECISIONS FOR BENIGN PROSTATIC HYPERPLASIA

Patients often want considerable information about their conditions, a nd enhanced patient participation might reduce unwanted practice varia tion and improve medical decisions. The authors assessed how men with benign prostatic hyperplasia reacted to an educational program designe d to facilitate participation in decisionmaking, and how strongly rati ngs of their symptom state and the prospect of complications predicted their treatment choice. A prospective cohort study was conducted in t hree hospital-based urology practices: two in prepaid group practices, and one Veterans Administration clinic. Four hundred twenty-one men w ith symptomatic benign prostatic hyperplasia without prior prostatecto my or benign prostatic hyperplasia complications were enrolled, and 37 3 provided usable ratings. Subjects participated in an interactive vid eodisc-based shared decisionmaking program about benign prostatic hype rplasia and its treatment options, prostatectomy, and ''watchful waiti ng.'' They rated the length, clarity, balance, and value of the progra m and were followed for 3 months to determine if they underwent surger y. Patients rated the program as generally clear, informative, and bal anced. Across all three sites, 77% of patients were very positive and 16% were generally positive about the program's usefulness in making a treatment decision. Logistic models predicting choice of surgical tre atment documented the independent importance of negative ratings of th e current symptom state (odds ratio 7.0, 95% confidence interval 2.9-1 6.6), as well as the prospect of postoperative sexual dysfunction (odd s ratio 0.20, 95% confidence interval 0.08-0.48) in decisionmaking. Pa tients rated the Shared Decisionmaking Program very positively and mad e decisions consistent with their assessed preferences. These results suggest that patients can be helped to participate in treatment decisi ons, and support a randomized trial of the Shared decisionmaking Progr am.