A decade ago, the National Institute of Medicine in the USA published a paper encouraging shared decision-making (SDM) between patients and their healthcare providers. This was based on the realization that patients, who felt that they had not been provided enough information, tended to regret their treatment decisions.
A new study out of Japan investigates this further by examining satisfaction with SDM between 150 physicians and 124 patients starting on ADT. As part of the study, patients completed a survey exploring whether 20 items had been explained by their health care provider(s). Items of discussion included diagnostic results and ADT’s "impact on daily life".
The researchers found "that the amount of information provided by the physicians before starting hormone therapy strongly influenced SDM." Importantly, though, "the amount of information provided by the physicians did not significantly influence the level of satisfaction with physician explanations." To quote further, the authors note: "to improve the level of satisfaction with physicians’ explanations, it is not necessarily enough to just increase the amount of information." In fact, the authors found no direct relationship between SDM and treatment satisfaction.
That last point is not surprising when one considers how profound the impact of the ADT can be. If a patient on ADT achieves good cancer control, with manageable side effects, one would expect him to have high satisfaction with ADT. Conversely, even if he initially thought it was a great idea to start on ADT— and felt bolstered by confidence-building SDM with his physician—if he didn’t have good cancer control with ADT, or if he was overwhelmed with adverse side effects, we would expect poor treatment satisfaction.
What is missing from this paper is any discussion about what physicians in Japan actually discuss with the patients about ADT’s “impact on daily life”. What side effects do they elect to discuss and what side effects do they avoid discussing? Are the discussions solely with the patients or are the partners of the patients also involved?
The impact of partners on treatment decision-making and what oncologists discuss with patients considering ADT has been explored in North America. It would be fascinating to know how similar or different this is in Japan.
To read the full article, see: https://pubmed.ncbi.nlm.nih.gov/33317523/
Nakayama K, Osaka W, Matsubara N, et al. Shared decision making, physicians' explanations, and treatment satisfaction: a cross-sectional survey of prostate cancer patients. BMC Med Inform Decis Mak. 2020;20(1):334. Published 2020 Dec 14. doi:10.1186/s12911-020-01355-z