How patients' preferences for risk information influence treatment choice in a case of high risk and high therapeutic uncertainty: Asymptomatic localized prostate cancer

To assess how patients' preferences for non-numerical risk information are related to their tendency to choose early surgical treatment for asymptomat ic gland-confined prostate cancer (a choice with high risk and high therape utic uncertainty), the authors conducted a cross-sectional study of 228 pat ients receiving continuing care in a general medicine clinic. After being p rovided with three data disclosures related to the treatment decision, subj ects were given a choice between surgery-now and watchful waiting. Data abo ut surgical complications were presented in numerical format. The subjects were also asked whether they preferred communication with their physician a bout the chance (probability) of adverse outcomes-related to management str ategies-in terms of words (such as possible or probable) or numbers (such a s percentages). Of the 226 patients who chose either surgery-now or watchfu l waiting, 71.2% preferred risk information in terms of words only or numbe rs only: 44% words only, and 56% numbers only. Younger patients (OR = 1.06 per year; CI = 1.02-1.10, p = 0.0008) and those wanting risk communication in terms of words only (OR = 2.41; CI = 1.24-4.70, p = 0.01) tended to pref er surgery-now over watchful waiting as the management strategy for asympto matic gland-confined prostate carcinoma. The authors conclude that there is a significant association between patients' preferences for risk communica tion with their physicians in terms of words only and a tendency to prefer early surgical intervention for prostate cancer when surgical risk data are provided numerically.