Choice For Men Research Articles

Priestly Celibacy: Theological Foundations by Gary Selin

Reviewed by: Priestly Celibacy: Theological Foundations by Gary Selin James Keating Priestly Celibacy: Theological Foundations by Gary Selin ( Washington, DC: Catholic University of America Press, 2016), 210 pp. Priestly celibacy is one of the more intriguing topics in Western Culture for a number of reasons, the largest being our preoccupation with ideas about and experiences of our human sexual power. A culture so obsessed with sexual activity becomes equally obsessed with those who choose to abstain from it. This cultural stance gives rise to a cynical curiosity about celibates, one that asks repeatedly, "how could you possibly live such a life?" and in the end says, "I don't believe you are living such a life; no one could." Selin's book may not heal such cynicism, but it will anoint the intellect with a balm, making such cynicism difficult even to contemplate. Celibacy is livable—but [End Page 672] in a supernatural way. Specifically, celibacy is livable for normal men who have first become stunned by the depth and beauty of Christ and have heard him ask one question: "May I live my spousal mysteries over again in your body for the sake of the Church?" Hence, the normal is taken up into the supernatural. When I was a teenager, I used to think men became priests, and hence celibate, because they "couldn't get girls to like them," because they thought, "I cannot get married; I might as well become a priest." This was the "plan B" theory of celibacy. Were there men who chose celibate priesthood as "plan B"? Probably there were—and still are. But in light of Selin's work, we see clearly how such a choice is not the gift that is being offered to priests. The gift that a priest is receiving and the choice he is making in response is a positive one, not a negative one. The gift is a man's choice to allow Christ to live his spousal mystery over again in his body, as Blessed Dom Marmion once said so beautifully. The celibate priest receives a gift. It is the gift of participation in Christ's own availability to serve the needs of his Bride, the Church. The priest is taken up into the spousal mysteries of Christ, his relationship to the Church, and his own carrying into the present a foretaste of heavenly freedom. With the celibate priest, Christ shares his own singular heart, thus effecting a living configuration between priest and Christ, a dynamic self-giving of priest toward the Church, and a prophetic sign for the baptized to contemplate as it hints at the single-heartedness of all in heaven. Selin's work could usher in a new day in seminary curriculum on priestly life and identity. Building upon the classic studies of celibacy by Cochini, Heid, and now John Paul II, along with the Second Vatican Council and Paul VI, Selin unveils an image of celibacy that carries profound theological depth and surprising personal and spiritual promise. In under two hundred pages, the author explores the theological history of celibacy, placing its vibrancy within close proximity to the mystery of Christ's self-donation to his Church. For Selin, following Presbyterorum Ordinis (1965), celibacy exists as a supernatural good within a Christological, ecclesiological, and eschatological context. Viewing it from within such a context is the good news for seminary studies, as this book gives the reader a clear and engaging intellectual grasp of the nature of this disciplined charismatic life. Selin acknowledges the institutional benefits of priestly celibacy for the Church, but what comes to the fore most in his research is the personal motivation for such a life. This emphasis upon a mature personal motive for entering the celibate priesthood reveals [End Page 673] more clearly the true divine intent behind such a call: personal happiness in the service of the Church. Celibacy is not superior to marriage in some moral way (i.e., "universal call to holiness"), but it remains a gifted theological life offered to those who can "accept it" (Matt 19:12). Selin reviews the anti-corporeal corruptions of some views of celibacy, articulates the meaning of "ritual purity...

Messaging Circumstances and Economic Pressures as Influences on Linkage to Medical Male Circumcision following Community-Based HIV Testing for Men in Rural Southwest Uganda: A Qualitative Study.

Voluntary medical male circumcision (MMC) reduces risk of HIV infection, but uptake remains suboptimal among certain age groups and locations in sub-Saharan Africa. We analysed qualitative data as part of the Linkages Study, a randomized controlled trial to evaluate community-based HIV testing and follow-up as interventions promoting linkage to HIV treatment and prevention in Uganda and South Africa. Fifty-two HIV-negative uncircumcised men participated in the qualitative study. They participated in semistructured individual interviews exploring (a) home HTC experience; (b) responses to test results; (c) efforts to access circumcision services; (d) outcomes of efforts; (e) experiences of follow-up support; and (f) local HIV education and support. Interviews were audio-recorded, translated, transcribed, and summarized into “linkage summaries.” Summaries were analysed inductively to identify the following three thematic experiences shaping men's circumcision choices: (1) intense relief upon receipt of an unanticipated seronegative diagnosis, (2) the role of peer support in overcoming fear, and (3) anticipation of missed economic productivity. Increased attention to the timing of demand creation activities, to who delivers information about the HIV prevention benefits of MMC, and to the importance of missed income during recovery as a barrier to uptake promises to strengthen and sharpen future MMC demand creation strategies.

Links between gendered leisure time in childhood and adolescence and gendered occupational aspirations

The world of work remains gender-segregated, and research is needed to identify factors that may give rise to women's and men's vocational choices. This study explored bidirectional relations between youth's gendered career aspirations and the proportions of youth's leisure time spent in stereotypically gendered activities and gendered social contexts. Participants were 203 youth (52% girls) from predominantly white, working and middle class families living in the US, who reported on their occupational aspirations and gendered interests in home interviews and on their daily activities in a series of 7 nightly phone interviews on two occasions, in middle childhood (Mage = 10.9) and in adolescence (Mage = 17.3). Path models revealed that aspirations predicted youth's time use more so than the reverse. Time in gendered social contexts, specifically time in female-only contexts, but not time in gender-typed activities, predicted career aspirations. Implications of these findings and suggestions for future research are discussed.

Aspirations to become an anaesthetist: longitudinal study of historical trends and trajectories of UK-qualified doctors\u2019 early career choices and of factors that have influenced their choices

BackgroundIt is important to inform medical educators and workforce planners in Anaesthesia about early career choices for the specialty, factors that influence them and to elucidate how recent choices of men and women doctors relate to the overall historical trends in the specialty’s popularity.MethodsWe analysed longitudinal data on career choice, based on self-completed questionnaires, from national year-of-qualification cohorts of UK-trained doctors from 1974 to 2012 surveyed one, three and 5 years post-qualification. Career destination data 10 years post-qualification were used for qualifiers between 1993 and 2002, to investigate the association between early choice and later destinations.ResultsIn years 1, 3 and 5 post-qualification, respectively, 59.9% (37,385), 64.6% (31,473), and 67.2% (24,971) of contactable doctors responded. There was an overall increase, from the early to the later cohorts, in the percentage of medical graduates who wished to enter anaesthesia: for instance year 1 choices rose from 4.6 to 9.4%, comparing the 1974 and 2012 cohorts. Men were more likely than women to express an early preference for a career in anaesthesia: for example, at year 3 after qualification anaesthesia was the choice of 10.1% of men and 7.9% of women. There was a striking increase in the certainty with which women chose anaesthesia as their future career specialty in recent compared to earlier cohorts, not reflected in any trends observed in men choosing anaesthesia.Sixty percent of doctors who were anaesthetists, 10 years after qualifying, had specified anaesthesia as their preferred specialty when surveyed in year 1, 80% in year 3, and 92% in year 5.Doctors working as anaesthetists were less likely than those working in other hospital specialties to have specified, as strong influences on specialty choice, ‘experience of the subject’ as students, ‘inclinations before medical school’, and ‘what I really want to do’. Men anaesthetists were more influenced in their specialty choice than men in other hospital specialties by ‘wanting a career with acceptable hours’; the corresponding difference among women was not significant.ConclusionsWe suggest a focus on inspirational teaching of anaesthesia in medical school and on greater exposure to the specialty in the foundation programme. Factors which may discourage women from entering anaesthesia should be explored and addressed.

Exogenous testosterone decreases men's personal distance in a social threat context

BackgroundTestosterone can motivate human approach and avoidance behavior. Specifically, the conscious recognition of and implicit reaction to angry facial expressions is influenced by testosterone. The study tested whether exogenous testosterone modulates the personal distance (PD) humans prefer in a social threat context. Methods82 healthy male participants underwent either transdermal testosterone (testosterone group) or placebo application (placebo group). Each participant performed a computerized stop-distance task before (T1) and 3.5h after (T2) treatment, during which they indicated how closely they would approach a human, animal or virtual character with varying emotional expression. ResultsMen's PD towards humans and animals varied as a function of their emotional expression. In the testosterone group, a pre-post comparison indicated that the administration of 50mg testosterone was associated with a small but significant reduction of men's PD towards aggressive individuals. Men in the placebo group did not change the initially chosen PD after placebo application independent of the condition. However comparing the testosterone and placebo group after testosterone administration did not reveal significant differences. While the behavioral effect was small and only observed as within-group effect it was repeatedly and selectively shown for men's PD choices towards an angry woman, angry man and angry dog in the testosterone group. In line with the literature, our findings in young men support the influential role of exogenous testosterone on male's approach behavior during social confrontations.

Clinical and molecular rationale to retain the cancer descriptor for Gleason score 6 disease.

Treatment choices for men with indolent prostate cancer include active surveillance or definitive local therapy. Overtreatment of these patients is an important current problem. Treatment decisions are often made jointly by the clinician and the patient, partly based on the tumour's Gleason score. To reduce the burden of overtreatment, the clinical significance of Gleason score 3 + 3 = 6 prostate cancer has been questioned and some have advocated that Gleason pattern 3 should be stripped of its cancer status. However, removing the cancer descriptor would have far-reaching clinical consequences that might result in poor patient outcomes, as the evidence of a lack of malignancy is inconclusive in several areas. For example, molecular data suggest that the genomic instability underlying tumour progression precedes histologically visible changes and the absolute risk of metastasis or mortality from Gleason score 6 prostate cancer is not zero. Extreme caution is required when weighing a decision to reclassify Gleason pattern 3 disease as a non-cancer.

Male Nurses in Israel: Barriers, Motivation, and How They Are Perceived by Nursing Students.

The current worldwide nursing shortage remains a challenge for the nursing profession. Encouraging men to become nurses and, thereby, increasing the number of practitioners are crucial factors in facing this challenge. The historiography of nursing presents nursing as "women's work," based on the assumption that it is inherently appropriate for women only. Although men were employed as nurses even before nursing was recognized as a profession, male nurses were always a minority in the field. Over the years, the proportion of male nurses has increased, but they still comprise only 5 to 10% of the nursing workforce in the western world. This study examined men's motives for a career choice of nursing, how male nurses are perceived, and the barriers that they face. The study was conducted among 336 nursing students studying in a co-educational program in various academic tracks at a public, nonsectarian university in the south of Israel. Participants completed the following questionnaires in one study session: sociodemographic questionnaire; Attitudes Towards Men in Nursing Scale; motives for career choice questionnaire; and the questionnaire of the perceptions of the professional status of nursing. Study findings revealed that men tended to choose nursing because of financial constraints significantly more frequently than women (P=.001). Among the participants, there was no significant between-sex difference in the perception nursing as women's work (P=.002) or in perception of male nurses as homosexuals. Results of the study showed that the status of the nursing profession is considered low, and the low status deters men from choosing nursing as a career. The motivation for men's career choice must be understood, and men must be empowered to improve their work conditions and financial remuneration in order to recruit men to the field and to improve the perception of the profession and its public status.

Usefulness of written information in treatment choice for men with low-risk prostate cancer

Usefulness of written information in treatment choice for men with low-risk prostate cancer

Abstract A48: Treatment decision making in a population-based sample of black and white men with localized prostate cancer

Abstract Background: Considerable controversy surrounds the optimal treatment for localized prostate cancer (LPC). Better understanding of men's treatment decision making process and its influencing factors may help men improve the quality of their treatment decision (e.g. decisional satisfaction, regret, or conflict). The influence of race on these factors is not well understood. We assessed the effects of men's personality, types of physicians seen, and involvement of family and friends on the treatment choice for LPC and the quality of this choice. Methods: A population-based sample of 154 men (85 white, 69 black) ≤ 75 years with newly diagnosed LPC were mailed a self-administered survey during a pilot study. Patient treatment choice, the reasons for the treatment choice, personality traits, and decisional qualities were assessed using either validated scales or scales developed based on literature review and qualitative research. Results: Mean age was 61(±7.3) years; 2/3 had >high school education. 59% chose surgery, 31% chose radiation, and 10% chose observation [watchful waiting/active surveillance (WW/AS)]. There were no racial differences in mean age, tumor risk level, number of comorbidities, or treatment choice. Compared to white men, black men were more likely to consult their family about their treatment decision (67% vs. 43%; p=0.01), more likely to have non-private insurance (29% vs. 12%, p=0.01), less likely to be married/partnered (71% vs. 90%, p<0.01), had higher faith (p<0.01), and had lower education (≤high school 43% vs. 25%, p=0.03). In multivariate analysis adjusting for age, race, comorbidity, and tumor risk level, men who saw only urologist(s) were more likely to report the desire to cure the cancer as the major reason for their treatment choice (p=0.01) compared to men who consulted more than urologist(s) (i.e. also saw a radiation oncologist and a primary care physician). Similarly, men who reported consulting a spouse (p<0.01) about their treatment decision were also more likely to report desire to cure the cancer as the major reason for their treatment choice. Men who consulted friends (p<0.01) or had higher education (p=0.02) were more likely to report a desire of avoiding side effects as the major reason for their treatment choice. In addition, men who consulted friends were more likely to choose curative treatment (radiation or surgery) versus observation (WW/AS) [OR=6.9, p<0.01; 6.4, p=0.01, respectively]. Men who reported desire to cure the cancer as a major reason for their decision were more likely to choose surgery compared to radiation or WW/AS [1.5, p=0.01; 1.6, p=0.03, respectively]. Compared to men who saw more than urologist(s) (radiation oncologist and PCP), men who saw urologist(s) only were less likely to choose radiation compared to surgery [0.14, p=0.04]. Furthermore, men who consulted family (3.0, p≤0.01) and friends (3.8, p≤0.01) were more likely to experience higher decisional conflict than men who did not, while these factors were not associated with decisional satisfaction or regret. None of the personality traits (pessimism, optimism, and faith) were associated with decisional qualities. Conclusions: In addition to types of physicians seen and desire to cure the cancer, consulting family, spouse, and/or friends were significantly associated with men's treatment choice for LPC. Consulting friends during the decision making process increased the odds of men choosing curative treatment (surgery or radiation) compared to observation (WW/AS). Furthermore, consulting friends and/or family also increased men's decisional conflict. These effects did not differ significantly between white and black men. Citation Format: Elyse Reamer, Felix Yang, Jinping Xu. Treatment decision making in a population-based sample of black and white men with localized prostate cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A48.

Gender and local soil knowledge: Linking farmers' perceptions with soil fertility in two villages in the Philippines

Scientists often turn to farmers to understand soil management. This process reveals differences and overlaps between local and scientific soil knowledge but rarely considers women and gender issues. This paper examines men's and women's local knowledge of soils in upland, smallholder farms in two villages in Mindanao, the Philippines, using focus group discussions, semi‐structured household interviews, field visits, GIS and soil testing. Farmers' field areas were calculated and delineated based on their perceptions of the different types of soils on their land. Men and women chose the same plots for what they considered their best soil but differed on what they felt were their worst. The fertility of the soils that women considered to be the best and worst was not significantly different from that of the men's respective choices. There was a difference in fertility, however, between the best and worst soils regardless of gender. Although soil fertility analyses showed that the women's chosen soils were similar to men's, analyses of qualitative data showed that their knowledge of soils was different and was based in part on a gendered division of labour. A multidisciplinary approach helped bridge the gap between sociocultural and physical research.

Masculinity in the doctor's office: Masculinity, gendered doctor preference and doctor–patient communication

ObjectiveMortality and morbidity data suggest that men have shorter life expectancies than women and outrank women on several leading causes of death. These gendered disparities may be influenced by psychosocial factors like masculinity. MethodsThree studies (Total N=546) examined the role of masculinity in men's doctor choices and doctor–patient interactions. In Studies 1 and 2, men completed measures of masculinity, gender bias, and doctor preference. Using structural equation modeling, we tested the direct relationship between masculinity and male doctor preference and the indirect relationship of masculinity on male doctor preference through an association with gendered competence stereotypes. Participants in Study 3 disclosed symptoms in private followed by disclosure to a male or female interviewer in a clinical setting. Using repeated measures analysis of variance (ANOVA), we examined the interaction among symptom reporting, masculinity and doctor gender, controlling for participant comfort. ResultsIn Study 1, results suggested that masculinity encouraged choice of a male doctor directly and indirectly via beliefs that men make more competent doctors than women; Study 2 directly replicated the results of Study 1. In Study 3, independent of participant comfort, an interaction between interviewer gender and masculinity emerged such that men scoring higher on masculinity reported symptoms less consistently to male interviewers (relative to higher scoring men reporting to female interviewers); the reverse was found for men scoring low on masculinity. ConclusionsTaken together these studies suggest that masculinity may affect men's health by encouraging choice of a male doctor with whom doctor–patient communication may be impaired.

Pathological Outcome following Radical Prostatectomy in Men with Prostate Specific Antigen Greater than 10 ng/ml and Histologically Favorable Risk Prostate Cancer

Active surveillance is now the treatment of choice in men with low risk prostate cancer. Although there is no consensus on which patients are eligible foractive surveillance, prostate specific antigen above 10 ng/ml is generally excluded. In an attempt to determine the validity of using a prostate specific antigen cutoff of 10 ng/ml to counsel men considering active surveillance we analyzed a multi-institution database to determine the pathological outcome in men with prostate specific antigen greater than 10 ng/ml but histologically favorable risk prostate cancer. We queried a prospectively maintained database of men with histologically favorable risk prostate cancer who underwent radical prostatectomy between 2003 and 2015. The cohort was categorized into 3 groups based on prostate specific antigen level, including low-less than 10 ng/ml, intermediate-10 or greater to less than 20 and high-20 or greater. Associations of prostate specific antigen group with adverse pathological and oncologic outcomes were analyzed. Of 2,125 patients 1,327 were categorized with histologically favorable risk disease. However on multivariate analyses the rates of up staging and upgrading were similar between the intermediate and low prostate specific antigen groups. In contrast compared to the intermediate prostate specific antigen group the high group had higher incidences of up staging (p = 0.02) and upgrading to 4 + 3 or greater disease (p = 0.046). Biochemical recurrence-free survival rates revealed no pairwise intergroup differences except between the low and high groups. Patients with preoperatively elevated prostate specific antigen between 10 and less than 20ng/ml who otherwise had histologically favorable risk prostate cancer were not at higher risk for adverse pathological outcomes than men with prostate specific antigen less than 10 ng/ml.

Racial Differences in Treatment Decision-Making for Men with Clinically Localized Prostate Cancer: a Population-Based Study.

Racial differences in prostate cancer treatment patterns have motivated concerns about over- and undertreatment. We surveyed black and white patients with localized prostate cancer (LPC) regarding their treatment decision-making processes to gain a better perspective on factors associated with LPC treatment choice. We conducted a population-based, cross-sectional survey of 260 men (132 black, 128 white) aged ≤75 years, with newly diagnosed LPC. Our primary outcome was treatment choice (either surgery, radiation, or watchful waiting/active surveillance (WW/AS)), and our primary predictors were race and tumor risk level. Overall, treatment choice did not differ by race. As cancer risk increased, both black and white patients were more likely to undergo surgery and less likely to receive radiation. However, the pattern of WW/AS was different between white and black men. White men were less likely to select WW/AS as cancer risk increased, while risk level was unrelated to black men undergoing WW/AS. Urologist's recommendation had the greatest impact on men's treatment choice, followed by tumor risk level, age, and personal preferences. Although there were no overall racial differences in treatment choice, when stratified by tumor risk level, the pattern of WW/AS was different between white and black patients, suggesting that over- and undertreatment is a larger concern for black than white men. A risk-stratified approach to understand racial disparities in LPC treatment and better strategies to aid black men in their treatment decision-making are needed to reduce racial disparities in prostate cancer outcomes.

Structure characterization of terazosin drug using mass spectrometry and thermal analyses techniques in comparison with semi-empirical molecular orbital (MO) calculations

Terazosin (C19H25N5O4, MW = 387) drug is a selective alpha 1 antagonist. It is used for lowering the blood pressure. Also, it used for treatment of symptoms of an enlarged prostate and is therefore a drug of choice for men with hypertension and prostate enlargement. In the present study, mass spectrometry (MS) and thermal analyses (TA) were used to investigate the fragmentation decomposition pathways of terazosin and confirmed by semi-empirical molecular orbital (MO) calculation, using PM3 procedure on the neutral and the positively charged species of the drug. These calculations included, bond length, bond order, partial charge distribution, ionization energy and heats of formation (ΔH f). The mass spectra and TA fragmentation pathways were proposed and compared to each other to select the most suitable scheme representing the correct fragmentation pathway of the drug in both techniques. This selection helps understanding of metabolism of the drug in vivo system. Therefore, comparison between MS and TA helps in selection, the proper pathway representing the fragmentation of this drug. This comparison successfully confirmed by MO calculation. In the present study, mass spectrometry (MS) and thermal analyses (TA) were used to investigate the fragmentation decomposition pathways of terazosin and confirmed by semi-empirical molecular orbital (MO) calculations. The mass spectra and thermal analyses fragmentation pathways were proposed and compared to each other to select the most suitable scheme representing the correct fragmentation pathway of the drug in both techniques. This selection helps understanding of metabolism of the drug in vivo system. Terazosin hydrochloride (C19H25N5O4) drug (marketed ITRIN), has an IUPAC name; 2-[4-(2-tetrahydrofuranyl) carbonyl]-1 piperazinyl- 6,7-dimethoxy-4-quinazolinamine monohydrochloride dihydrate, and its stereo structure is given below

Deliberative democracy and cancer screening consent: a randomised control trial of the effect of a community jury on men's knowledge about and intentions to participate in PSA screening

ObjectiveProstate-specific antigen (PSA) screening is controversial. A community jury allows presentation of complex information and may clarify how participants view screening after being well-informed. We examined whether participating in a...

Leisure Helps Get the Job Done

This paper presents empirical findings of how hegemonic masculinity influenced college-aged men's choices about using leisure activities to negotiate stress. Among our participants, there was a pattern of employing specific types of leisure to escape stress. Participants reported that their understandings of masculinity involved stress as part of being action-oriented and getting the job done, and that engaging in leisure activities was how they escaped pressures. Leisure activities perceived as masculine allowed participants time to build the energy, both physical and mental, necessary to negotiate stress. Based on the analysis of in-depth interviews, three categories emerged: masculinity involves getting the job done, stress is part of getting the job done, and masculine leisure helps escape stress.

Choosing Your Country: Networks, Perceptions and Destination Selection among Georgian Labour Migrants

Existing literature demonstrates that social networks play a key role in international migrants' selection of destinations. But how do such networks begin? The Republic of Georgia is an example of a country from which migrants travel to many different destination countries, most of which had no Georgian population before the collapse of the Soviet Union. This paper uses a combination of nationally representative survey data and semi-structured interviews to identify the patterns and logic of men's and women's destination choices. I find that a wide variety of micro- and macro-level factors influence the desirability of destinations and that perceived gender differences in the labour market demands of the destination countries and variation in the accessibility of different countries explain much of the variation in destination selection among migrants. Social networks play a vital role in shaping perceptions of destination countries, which can be highly localised and changeable in the early stages of migration.

An experimental study of gender differences in distributive justice

This paper shows that women are more likely than men to employ the fair allocation that most benefits their financial payoff. The experimental evidence is gleaned from a dictator game with production, in which subjects first solve a quiz to accumulate earnings and then divide the surplus by choosing one over five different allocations, some of which represent a fairness ideal. The data also suggest that women are more sensitive to the context as their allocation choices depend on whether they have accumulated more or less money than their counterparts. This is not the case for the men's allocation choices.

“He Does Not Love Me, Nor I He!” The Critic's Love is of Critique, not of Law

Attempting to create an image, a figure adequate to the critic's discourse on the law, this paper develops a series of variations on the notion of the critic's love for the law, responding to the comments of Peter Goodrich and Oren Ben-Dor, both of whom criticised critique for not breaking with law, for remaining internal to law. Taking their positions perhaps more literally than intended, Goodrich's “love” is considered as an instance of Freud's analysis of what motivates some men's object choice in love, which is then read allegorically, and Ben-Dor's “anticipation” is considered as a version of the story of Tristan and Iseult, as interpreted by de Rougemont. Both are revealed to be instances of mis-identification, with, however, the critic's delusion redeemed as nobler than that of the spouse, perhaps even a more profound knowledge. The critic loves, the apologetic espouses. The critic's work is not a useless passion.

Impact of a novel decision counseling program on treatment knowledge, decisional conflict, and choice in men with early-stage, low-risk prostate cancer.

9 Background: Active surveillance (AS - serial follow-up PSA, exam, and biopsy) is an option for men with early stage, low risk prostate cancer (LRPca). While data show comparable survival for AS vs active treatment (AT - surgery or radiation), currently most men with LRPca undergo AT. A pilot Decision Counseling Program (DCP) to assist men in making an informed, shared LRPca treatment decision was implemented. Methods: Men with LRPca seen at the Jefferson Genitourinary Multidisciplinary Cancer Center (JGUMDCC) were consented. A nurse educator (NE) reviewed risks/benefits of AS and AT; had the participant identify factors influencing treatment decision making and specify decision factor weights; entered data into an online DCP; and generated a report of participant treatment preference and decision factors. The report was used by the participant and clinicians in shared treatment decision making. A follow-up survey was administered 30 days after the visit, with treatment status assessed. Change in treatment-related knowledge and decisional conflict were measured using baseline and 30-day survey data. Results: Baseline decision counseling preference of 16 participants: 4 - AS, 8 equal for AS and AT, 4 - AT. At 30 days, 12 participants initiated AS, 4 chose AT; participant mean treatment knowledge scores (8-point scale) increased (+1.13 points); decisional conflict subscale scores (strongly disagree = 1, strongly agree = 5) decreased (uncertain: -1.15, uninformed: -1.36, unclear: -1.12; and unsupported: -1.15). Conclusions: Decision counseling and shared decision making helped participants become better informed about treatment choices and reduced uncertainty in treatment decision making. The combined intervention resulted in most participants choosing AS. Ongoing study recruitment, data collection, and analyses are planned.