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Patient Education Materials about the Treatment of Early-Stage Prostate Cancer: A Critical Review

Angela Fagerlin, PhD; David Rovner, MD; Sue Stableford, MPH, MSB; Christophir Jentoft, BA; John T. Wei, MD; and Margaret Holmes-Rovner, PhD
[+] Article, Author, and Disclosure Information

From the Veterans Administration Center for Practice Management and Outcomes Research, Veterans Administration Healthcare System, Program for Improving Health Care Decisions, and University of Michigan, Ann Arbor, Michigan; Michigan State University, East Lansing, Michigan; and Maine Area Health Education Center Health Literacy Center, University of New England, Biddeford, Maine.

Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Acknowledgments: The authors thank Brian Dishinger, Emily Hacker, Mark Rabbat, and Ruth Rashid for their research assistance, Todd Roberts for his assistance with the preparation of the manuscript, and Carl Schneider, JD, for his thoughtful comments on a previous draft.

Grant Support: This project was commissioned and supported by the Michigan Department of Community Health and the Michigan Public Health Institute with funds from the Centers for Disease Control and Prevention. The Michigan Cancer Consortium Prostate Cancer Action Committee actively participated in identifying patient education materials for review and in reviewing findings of the analysis.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Angela Fagerlin, PhD, Division of General Medicine, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI 48109-0429; e-mail, fagerlin@umich.edu.

Current Author Addresses: Dr. Fagerlin: Division of General Medicine, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI 48109-0429.

Dr. Rovner: Department of Medicine, Michigan State University, B336 Clinical Center, East Lansing, MI 48824.

Ms. Stableford: AHEC Health Literacy Center, University of New England, 11 Hills Beach Road, Biddeford, ME 04005.

Mr. Jentoft: 1737 Nemoke Trail #4, Haslett, MI 48840.

Dr. Wei: Department of Urology, The University of Michigan, 1500 East Medical Center Drive, Women's Trailer Room 1013, Ann Arbor, MI 48109-0759.

Dr. Holmes-Rovner: Department of Medicine, Michigan State University, B411 Clinical Center, East Lansing, MI 48824.

Ann Intern Med. 2004;140(9):721-728. doi:10.7326/0003-4819-140-9-200405040-00012
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Background: To ensure that patients make informed medical decisions, patient education materials must communicate treatment risks and benefits.

Objective: To survey publicly available patient education materials and assess their suitability to support informed decision making in early-stage prostate cancer.

Design: Cross-sectional review of Internet, print, and multimedia sources.

Setting: University data analysis laboratory.

Measurements: The content of 44 materials that described all standard treatment options was reviewed. Top-rated documents underwent plain-language review. Total score on 54 content items and accuracy, balance, and plain-language evaluation was measured.

Results: 502 of 546 patient education materials did not describe all standard treatments (watchful waiting, surgery, radiation, and hormone therapy). Eighty percent of the 44 materials that addressed standard treatments and underwent content review described anatomy, physiology, stage, and grade of cancer. Half of the materials fully described radical prostatectomy and radiation therapy. One third of the materials included risks and benefits of each treatment; none explicitly compared outcomes of all treatments in a single summary. Information was accurate and balanced but did not include key content for informed consent.

Limitations: The search was restricted to publicly available materials and did not include books or materials written in languages other than English. The accuracy, balance, and plain-language reviews were evaluated by 1 reviewer. The criteria reflect the authors' focus on informed decision making. Other aspects of health education may require a different evaluation template.

Conclusions: Currently available patient education materials on early-stage prostate cancer treatment do not contain comprehensive information about the risks and benefits of each treatment. To assist patients and physicians in choosing among prostate cancer treatment options, a new generation of materials is needed.





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