At a time where patient-centered healthcare is greatly emphasized, the effect of shared doctor-patient decisions is still probably minimal as a consequence of the knowledge gap between each other.
Researchers from the Group Health Research Institute, Seattle, have implemented video aids for men with benign prostatic hyperplasia (BPH) and localized (i.e., early and not spread throughout the body) prostate cancer to enhance informed decision upon treatment.
Benign prostate hyperplasia is a condition characterized by the enlargement of the prostate that affects approximately 50% of men by the age of 50 years and 75% of men by the age of 80 years. It is associated with various symptoms including voiding difficulties and higher urinary frequency. On the other hand, prostate cancer is usually a slow growing malignancy that affects as much as 30 to 70% of males over 60 years of age and can usually be treated without actual surgery.
The study, led by senior author Dr. Richard Hoffman, introduced videos to explain the various treatment options for these two diseases in several urology clinics. The videos explained the advantages and disadvantages of all common medical and surgical treatment options. Previous evidence showed that no single treatment option is clearly superior, and the benefits and risks of each treatment are different. Moreover, some informed patients choose to avoid any treatment whatsoever.
Results showed that men with BPH treated with oral medications, when exposed to the informational videos, did not choose surgical approaches as often. Additionally, men with localized prostate cancer did not choose intensive treatment (medications, surgery or radiotherapy) as often.
Nevertheless, although there is a trend toward lower healthcare costs after the implementation of these video decision aids, the results did not reach statistical significance. This can be due to the sample size that only included 4,000 patients, which was not large enough to detect the differences or higher costs on more doctor visits for surveillance of localized cancer patients.
Previous evidence has shown that patients are more likely to make informed choices when provided with easy and evidenced-based information about treatment advantages and disadvantages. In the end, they choose more conservative, less invasive options and are usually more satisfied regardless of the outcomes.
This study proves thar patients with BPH and localized prostate cancer should be included in a shared decision concerning treatment and, when well informed, may change their final approach to the disease.