CommentaryChoosing Health, Choosing Treatment: Patient Choice After Diagnosis of Localized Prostate Cancer
Section snippets
Policy
The U.K. White paper titled Choosing Health: Making Health Choices Easier, has outlined a commitment to patient choice. More specifically, this is a move away from a system that knows how to make people healthy to a health service that supports people in making choices about their health. Patient treatment decisions are more complicated than in other areas of a consumer society. Consumer choice in health is problematized through the often complex nature of treatment and the limited access
Service Delivery
The U.K. health services are implementing changes with the intention of supporting men diagnosed with localized prostate cancer in making the decision that best suits their needs and preferences. The centralization of some specialist services, such as surgery for localized prostate cancer, will add another element to treatment choice for some men and their caregivers. We introduce one service that is implementing choice, alongside centralization of specialist services, to establish how the U.K.
Patients' Perspective
A number of treatment options are available for prostate cancer, such as prostatectomy, brachytherapy, conformal radiotherapy, cryotherapy, and high-intensity ultrasound (Table 1). Treatment can even be avoided forever, or long delayed, such as with watchful waiting or active surveillance. For those diagnosed with localized prostate cancer, treatment can have significant side effects10; thus, patient choice policies and the service changes implementing those policies need to incorporate
Research
Because it is patients and caregivers who actually go through the period of deciding on treatment, they have expertise that will benefit research about patient choice, not just through an advisory capacity, but also in the process of the investigation. More specifically, exploring patients “experiences” requires researchers to make some assumptions when deciding which issues to emphasize and how best to explore them. Evidence of a mismatch has been demonstrated between the cancer research
Conclusions
Government guidelines (from the NICE) now recommend a number of treatment options (eg, watchful waiting, active surveillance, prostatectomy, brachytherapy, and conformal radiotherapy) as appropriate for each level of localized prostate cancer (low, intermediate, and high risk) and state that it is patients who must decide among them.
U.K. health services are implementing changes with the intention of supporting men diagnosed with localized prostate cancer in making the decision that best suits
Acknowledgment
To Karl Witty and Steve Robertson for their comments on earlier drafts of this report.
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Reply by the Authors
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2015, Journal of Health CommunicationToward ethically responsible choice architecture in prostate cancer treatment decision-making
2015, CA Cancer Journal for Clinicians
P. Branney received a grant from the U.K. Department of Health and has made grant applications to the Prostate Cancer Charity; S. Jain, P. Flowers, and A. White have made grant applications to the Prostate Cancer Charity; and C. Hiley was Head of Policy and Research at the U.K. Prostate Cancer Charity.