Preferred Role In Decision Research Articles

Clinical decision-making: physicians' preferences and experiences

BackgroundShared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1) physician preferences for different styles of clinical decision-making; 2) styles of clinical decision-making physicians perceive themselves as practicing; and 3) the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information.MethodsCross-sectional survey of a nationally representative sample of U.S. physicians.Results1,050 (53% response rate) physicians responded to the survey. Of these, 780 (75%) preferred to share decision-making with their patients, 142 (14%) preferred paternalism, and 118 (11%) preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits.ConclusionPhysicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

Primary health care professionals’ views on barriers and facilitators to the implementation of the Ottawa Decision Support Framework in practice

Objective To describe primary health care professionals’ views on barriers and facilitators for implementing the Ottawa Decision Support Framework (ODSF) in their practice. Methods Thirteen focus groups with 118 primary health care professionals were performed. A taxonomy of barriers and facilitators to implementing clinical practice guidelines was used to content-analyse the following sources: reports from each workshop, field notes from the principal investigator and written materials collected from the participants. Results Applicability of the ODSF to the practice population, process outcome expectation, asking patients about their preferred role in decision making, perception that the ODSF was modifiable, time issues, familiarity with the ODSF and its practicability were the most frequently identified both as barriers as well as facilitators. Forgetting about the ODSF, interpretation of evidence, challenge to autonomy and total lack of agreement with using the ODSF in general were identified only as barriers. Asking about values, health professional's outcome expectation, compatibility with the patient-centered approach or the evidence-based approach, ease of understanding and implementation, and ease of communicating the ODSF were identified only as facilitators. Conclusion These results provide insight on the type of interventions that could be developed in order to implement the ODSF in academic primary care practice. Practice implications Interventions to implement the ODSF in primary care practice will need to address a broad range of factors at the levels of the health professionals, the patients and the health care system.

Understanding Cardiopulmonary Resuscitation Decision Making: Perspectives of Seriously Ill Hospitalized Patients and Family Members

To improve communication and decision making related to cardiopulmonary resuscitation (CPR), a greater understanding of the perspectives of hospitalized patients with advanced diseases and their family members are needed. In five Canadian hospitals, we administered a face-to-face questionnaire to older inpatients with end-stage cancer and advanced medical diseases and, where possible, to one of their family members, regarding information needs, the deliberation process, and their preferred decisional role. A total of 440 of 569 patients (78%) and 160 of 176 available caregivers (91%) agreed to participate. Most patients (61%) had thought about what treatment they wanted if their heart stopped, few patients (11.3%) could describe more than two components of CPR, and only 2.7% of patients thought that the success rate of CPR was < 10%. A minority of patients (34%) had discussed CPR with their physician; 37% did not want to discuss their preferences with their doctor. Patients who felt that end-of-life issues were relevant to them were 5.5 times more likely to want a discussion with the physician regarding resuscitation (odds ratio, 5.5; 95% confidence interval, 2.5 to 12.0). The preferred role in decision making was variable, but most patients (59.7%) and family members (81.6%) preferred some degree of shared decision making that included the family member. There were no significant differences between cancer and medical patients in their preferred decisional role. Seriously ill hospitalized patients have poor knowledge about CPR, and variable preferences for deliberation and their role in the decision-making process regarding their treatment. Strategies that improve understanding of CPR and foster discussions that involve patients, family members, and physicians in the decision-making process may improve the quantity and quality of communication and decision making about CPR.

The decision-making experience among women diagnosed with stage I and II breast cancer

A cancer diagnosis signals entry for many patients into the complex and often bewildering world of cancer care. Understanding the role women prefer and their level of satisfaction with the decision-making process at time of diagnosis will help to inform healthcare professionals how to better support breast cancer patients as they navigate the cancer journey. Logistic regression was used to identify significant factors influencing outcomes in role preferences and satisfaction. A complementary method, principal components analysis was used to explore patterns of co-association between outcomes and their influencing factors. Results showed women tended to adopt cancer decision-making roles similar to those used for general health decision-making. Overall, women preferred a collaborative/active role (40/38%) over a passive role (16%). Satisfaction rates were high with 88.1% of women being satisfied/very satisfied with their cancer treatment choice; 89.7% of women satisfied with their decision-making role and; 83.6% satisfied with the information provided to support their decision. Further research involving cohorts of women diagnosed with more advanced disease and for whom decisional regret may be greater, is needed to further explore the link between preferred decision-making role and satisfaction.

Problem-solving and decision-making preferences: No difference between complementary and alternative medicine users and non-users

The objective of this study was to determine if complementary and alternative medicine (CAM) Users are more autonomous than Non-Users with respect to their preferred role in decision-making (measured by the problem-solving decision-making or PSDM scale). A survey was mailed in spring 2001 to a random sample of 696 men (selected from the Ontario Cancer Registry), aged 18 years or older and diagnosed with prostate cancer in the preceding 2 years. Less than 5% of the 489 (72.1% response rate) men (mean age 68.6 years) who responded to the PSDM question in our survey were classified as having an autonomous role preference, while almost 1/3 of the respondents reported using CAM for their prostate cancer. The majority of respondents were classified as preferring a shared role and a substantial minority was classified as preferring a passive role. There was no statistically significant difference between CAM users and non-users with respect to their preferred role. The hypothesis that CAM Users are more autonomous problem solvers and decision makers is not supported by these findings; however, the generalizability of our results is limited by the fact that we surveyed a relatively older male population only.

Stability of decisional role preference over the course of cancer therapy

Cancer patients vary in their preferred level of involvement in medical decision making, and responding to patients' desired level of involvement is a key element of good medical care. While the literature has clearly demonstrated heterogeneity among cancer patients' preferences, less is known about how the preferences of any given patient may change over time. This longitudinal study compared cancer patients' preferences for involvement in medical decision making from the time of diagnosis to the time of completion of therapy. Data from 729 cancer patients with mixed diagnoses were analyzed. Most patients reported a change in preferred level of involvement over time, and multivariate analysis demonstrated that patients tend to prefer a decreasing level of involvement over time (p<0.0001). Stability of patients' preferences was also associated with type of cancer, but not with other sociodemographic characteristics. The results from this study highlight the importance of reevaluating patients' preferences for involvement in medical decision making throughout the course of cancer therapy, as such preferences are likely to change.

The information needs and preferred roles in treatment decision‐making of parents caring for infants with atopic dermatitis: a qualitative study

Information needs and preferences in treatment decision-making of parents caring for infants with atopic dermatitis (AD) are unknown, despite emphasis on quality information-giving and involvement of health-care users in treatment decisions. To explore information needs and decisional role-preferences of parents caring for infants with AD. Qualitative study. Purposive sample: 31 parents caring for infants with AD. Tape-recorded focussed conversation-style interviews. Interview topic-guide literature-derived. Control Preferences Scale (5 sort-card vignettes 'very active' to 'very passive' role) adapted for use with parents; used to facilitate discussion. Thematic analysis of verbatim transcripts. Nine core information needs identified: AD-causation, role of diet, medication-use, medication-side-effects, exacerbating factors, new/alternative medication, nonpharmacological treatments, AD-prevention, AD and other atopic conditions. Parents desired verbal and written information. Many felt their baby's condition was not taken seriously, leading to delayed diagnosis and treatment. They had to be more active than they wished to obtain information/treatment. Parents preferred sharing decisions with their doctor. Parents caring for infants with AD have clearly defined, unmet information needs, forcing them into more active roles in the treatment decision-making process than they desire. The study-findings may inform the development of written information specifically for these parents and improve partnership during consultations.

Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer

This study sought to examine the relationships between decisional role (preferred and assumed) at time of surgical treatment (baseline), congruence between assumed role at baseline and preferred role 3 years later (follow-up), and quality of life at follow-up. Two hundred and five women diagnosed with breast cancer completed the decisional role preference scale at baseline and follow-up, and the EORTC QLQ-C30 at follow-up. A statistically significant number of women had decisional role regret, with most of these women preferring greater involvement in treatment planning than was afforded them. Women who indicated at baseline that they were actively involved in choosing their surgical treatment had significantly higher overall quality of life at follow-up than women who indicated passive involvement. These actively involved women had significantly higher physical and social functioning and significantly less fatigue than women who assumed a passive role. Quality of life was significantly related to reports of experienced involvement in treatment decision making, but not to reports of preferred involvement, or congruence between preferred and experienced involvement.

Decisional role preferences, risk knowledge and information interests in patients with multiple sclerosis

Shared decision making is increasingly recognized as the ideal model of patient-physician communication especially in chronic diseases with partially effective treatments as multiple sclerosis (MS). To evaluate prerequisite factors for this kind of decision making we studied patients' decisional role preferences in medical decision making, knowledge on risks, information interests and the relations between these factors in MS. After conducting focus groups to generate hypotheses, 219 randomly selected patients from the MS Outpatient Clinic register (n = 1374) of the University Hospital Hamburg received mailed questionnaires on their knowledge of risks in MS, their perception of their own level of knowledge, information interests and role preferences. Most patients (79%) indicated that they preferred an active role in treatment decisions giving the shared decision and the informed choice model the highest priority. MS risk knowledge was low but questionnaire results depended on disease course, disease duration and ongoing immune therapy. Measured knowledge as well as perceived knowledge was only weakly correlated with preferences of active roles. Major information interests were related to symptom alleviation, diagnostic procedures and prognosis. Patients with MS claimed autonomous roles in their health care decisions. The weak correlation between knowledge and preferences for active roles implicates that other factors largely influence role preferences.

Providing audiotapes of primary adjuvant treatment consultations to men with prostate cancer: Impact on recall, mood, satisfaction, and quality of life

8009 Background: Previously we reported on the benefits of providing audiotapes of primary adjuvant treatment consultations to women with newly diagnosed breast cancer (Hack et al; Proc ASCO 2001). The purpose of this multi-site, randomized controlled trial was to use similar methods to examine the efficacy of providing men with prostate cancer with an audiotape of their primary adjuvant treatment consultation. Methods: A total of 429 men and 15 oncologists from cancer centres in three Canadian cities participated. The men were block randomized to 1 of 4 consultation groups: 1. Standard Care Control Group - Consultation not audiotaped (n=113); 2. Patient not given audiotape (n=98); 3. Patient given audiotape (n=120); and 4. Patient offered choice of receiving the audiotape (n=94 accepted tape, n=4 declined tape). Patients completed the Decisional Role Preferences Scale (Degner) before and after the consultation, a measure of communication satisfaction post-consultation, and measures of decisional role, audiotape use, information recall, communication satisfaction, mood disturbance (Profile of Mood States), and prostate cancer-specific quality of life (FACT-P) at 3 months post-consultation. A feedback questionnaire was mailed to all participating oncologists. Results: Analyses of covariance showed that patients who received the consultation audiotape reported having had significantly more discussion about treatment side effects (p<.01), treatment alternatives (p<.05), and treatment and disease information in general (p<.05) than patients who did not receive the audiotape. Patients rated the audiotape intervention positively, with an average score of 83.0 out of 100. Fifty-six percent of oncologists stated that most, if not all, patients should be provided with an audiotape of their primary adjuvant treatment consultations. Conclusions: Audiotapes of primary adjuvant treatment consultations are rated beneficial by prostate cancer patients and their oncologists, and aid patients by facilitating perception of being informed of treatment alternatives and treatment side effects. No significant financial relationships to disclose.

Providing audiotapes of primary adjuvant treatment consultations to men with prostate cancer: Impact on recall, mood, satisfaction, and quality of life

8009 Background: Previously we reported on the benefits of providing audiotapes of primary adjuvant treatment consultations to women with newly diagnosed breast cancer (Hack et al; Proc ASCO 2001). The purpose of this multi-site, randomized controlled trial was to use similar methods to examine the efficacy of providing men with prostate cancer with an audiotape of their primary adjuvant treatment consultation. Methods: A total of 429 men and 15 oncologists from cancer centres in three Canadian cities participated. The men were block randomized to 1 of 4 consultation groups: 1. Standard Care Control Group - Consultation not audiotaped (n=113); 2. Patient not given audiotape (n=98); 3. Patient given audiotape (n=120); and 4. Patient offered choice of receiving the audiotape (n=94 accepted tape, n=4 declined tape). Patients completed the Decisional Role Preferences Scale (Degner) before and after the consultation, a measure of communication satisfaction post-consultation, and measures of decisional role, audiotape use, information recall, communication satisfaction, mood disturbance (Profile of Mood States), and prostate cancer-specific quality of life (FACT-P) at 3 months post-consultation. A feedback questionnaire was mailed to all participating oncologists. Results: Analyses of covariance showed that patients who received the consultation audiotape reported having had significantly more discussion about treatment side effects (p<.01), treatment alternatives (p<.05), and treatment and disease information in general (p<.05) than patients who did not receive the audiotape. Patients rated the audiotape intervention positively, with an average score of 83.0 out of 100. Fifty-six percent of oncologists stated that most, if not all, patients should be provided with an audiotape of their primary adjuvant treatment consultations. Conclusions: Audiotapes of primary adjuvant treatment consultations are rated beneficial by prostate cancer patients and their oncologists, and aid patients by facilitating perception of being informed of treatment alternatives and treatment side effects. No significant financial relationships to disclose.

Communicating evidence for participatory decision making.

Informed patients are more likely to actively participate in their care, make wiser decisions, come to a common understanding with their physicians, and adhere more fully to treatment; however, currently there are no evidence-based guidelines for discussing clinical evidence with patients in the process of making medical decisions. To identify ways to communicate evidence that improve patient understanding, involvement in decisions, and outcomes. Systematic review of MEDLINE for the period 1966-2003 and review of reference lists of retrieved articles to identify original research dealing with communication between clinicians and patients and directly addressing methods of presenting clinical evidence to patients. Two investigators and a research assistant screened 367 abstracts and 2 investigators reviewed 51 full-text articles, yielding 8 potentially relevant articles. Methods for communicating clinical evidence to patients include nonquantitative general terms, numerical translation of clinical evidence, graphical representations, and decision aids. Focus-group data suggest presenting options and/or equipoise before asking patients about preferred decision-making roles or formats for presenting details. Relative risk reductions may be misleading; absolute risk is preferred. Order of information presented and time-frame of outcomes can bias patient understanding. Limited evidence supports use of human stick figure graphics or faces for single probabilities and vertical bar graphs for comparative information. Less-educated and older patients preferred proportions to percentages and did not appreciate confidence intervals. Studies of decision aids rarely addressed patient-physician communication directly. No studies addressed clinical outcomes of discussions of clinical evidence. There is a paucity of evidence to guide how physicians can most effectively share clinical evidence with patients facing decisions; however, basing our recommendations largely on related studies and expert opinion, we describe means of accomplishing 5 communication tasks to address in framing and communicating clinical evidence: understanding the patient's (and family members') experience and expectations; building partnership; providing evidence, including a balanced discussion of uncertainties; presenting recommendations informed by clinical judgment and patient preferences; and checking for understanding and agreement.

Decision-Making Role Preferences of Patients Receiving Adjuvant Cancer Treatment: A University of Rochester Cancer Center Community Clinical Oncology Program

This study examined patients' preferences for involvement in treatment decision-making. This was a multisite survey study of 1014 patients diagnosed with a variety of cancers. Patients' treatment decisions, role preferences, and characteristics were assessed with a questionnaire administered at the time of their first visit with a medical or radiation oncologist. The data showed that 35.7% preferred passive roles, 43.7% preferred shared roles, and 20.3% preferred active roles in decision-making. Bivariate analyses indicated that patients with a college education or in professional or managerial occupations preferred more active roles in decisionmaking compared with other patients. Similarly, men with prostate cancer and women with breast cancer, compared with other patients, also preferred more involvement in decision-making. Age was not associated with decision-making role preferences. Avoidant and fatalistic coping were associated with a passive decision-making role. Multinomial logistic regression analysis found that patients in professional/managerial occupations preferred a shared role (odds ratio [OR], 1.6; CI, 1.2–2.4) or an active role (OR, 2.3; CI, 1.5–3.5) compared with patients in other occupations. Patients with prostate or breast cancer preferred shared (OR, 2.3; CI, 1.6–3.2) or active roles (OR, 1.8; CI, 1.2–2.8) compared with patients with other diagnoses. Patients who scored higher on the Mental Adjustment to Cancer fatalism scale were less likely to prefer shared (OR, 0.94; CI, 0.89–0.99) or active roles (OR, 0.90; CI, 0.84–0.96) compared with patients with a less fatalistic orientation. Decision-making role preferences were influenced by multiple factors. Most patients wanted a shared or active role in treatment decision-making. Our results suggest that some patients may require encouragement to take a shared or active role in decision-making.

Women's satisfaction with their involvement in health care decisions during a high-risk pregnancy.

Increasingly, women seek involvement in decisions about their health care. The purpose of this study was to examine women's experience of, and satisfaction with, their involvement in health care decisions during a high-risk pregnancy. Forty-seven women with hypertension or threatened preterm delivery (including multiple births) were interviewed after the birth of their child. They received prenatal care at home from nurses in a community program or were hospitalized. The in-depth interviews were audiotaped and transcribed; data were analyzed using constant comparative methods. Women identified an increased feeling of responsibility for the health of their baby and themselves, but differed in choosing active or passive involvement in health care decisions. Women who wanted active involvement achieved it through one of three processes: struggling for, negotiating, or being encouraged. Women who wanted passive involvement and women facing health crises used the process of trusting in the expertise of nurses and physicians. Women were satisfied if the care from health care professionals was congruent with how they wanted to be involved in decision-making. Although most women want to be actively involved in health decision-making during a high-risk pregnancy, some prefer a passive role. The setting of prenatal care, community-based or in-hospital, was less important than the ability of nurses and physicians to support the woman in her preferred role in decision-making.

Parents' decision-making preferences in pediatric oncology: the relationship to health care involvement and complementary therapy use.

This study investigated how parents' preferred level of control in treatment decision-making is related to their personal health care involvement and to their decision to use complementary therapies (CTs) for their child. One hundred-eighteen parents of pediatric oncology patients completed an anonymous CT survey. The Krantz Health Opinion Survey (KHOS) was used to determine parents' preferred involvement in personal health care, and the Control Preferences Scale for Pediatrics (CPS-P) measured preferred role in pediatric treatment decision-making. Unlike previous studies of adult cancer patients, most parents preferred active or collaborative decision-making. The KHOS and CPS-P were significantly correlated, indicating that parents' preferred role in children's treatment decisions was related to their own personal health care involvement. Forty-six percent of parents used CTs for their child, and 33% began using a new CT after diagnosis. The hypothesized relationship between CT use and parents' own health care involvement was partially supported. Preference for control in decision-making was not associated with CT use. These findings provide validation for the newly developed CPS-P and indicate that parents' decisions to use CT for their child are related in part to individual health care preferences.

The seriously ill hospitalized patient: Preferred role in end-of-life decision making?

Purpose: The objective of this study was to further our understanding of the decision-making process near the end of life. Specifically, we ascertained the seriously ill patients' preferred role in the decision-making process, what factors were associated with this role, and how this stated preference related to physicians' perception of preferred role. Materials and Methods: Prospective cohort study of hospitalized patients with end-stage congestive heart disease, chronic pulmonary disease, cirrhosis, or metastatic cancer. Eligible patients were interviewed to ascertain their personal views on end-of-life decision making, desired role, and level of symptoms experienced. Results: A total of 135 patients were enrolled in this study. The majority of patients (103, 76%) had thought about end-of-life issues although only 48 (36%) had discussed them with their doctor in the hospital. With respect to preferred role in decision making, in the scenario of a competent patient, 14 (10%) preferred to leave all decisions to the doctor, 12 (9%) preferred that the doctor make the final decision after considering their opinion, 43 (32%) preferred that the doctor shared responsibility with them to make the decision, 32 (24%) patients preferred to make the final decision after considering the doctor's opinion, 21 (16%) preferred to make the treatment decision alone, and 13 (10%) did not answer. Physicians were not able to accurately predict patient's preferred role nor could the variability in patient choice be accounted for by demographic or symptom covariates. Conclusion: Seriously ill hospitalized patients desire to discuss end-of-life issues with their physicians but their preferred role in decision making is variable and difficult to predict. Copyright 2003 Elsevier, Inc. All rights reserved.

Patients' role in treatment decision-making

Aims To assess the transferability of the Control Preferences Scale to dental settings and to explore patients' preferred and perceived roles in dental treatment decision-making. Setting and participants A convenience sample of 40 patients, 20 recruited from the University Dental Hospital of Manchester and 20 from a general dental practice in Cheshire. Methods A cross-sectional survey, using the Control Preferences Scale, a set of sort cards outlining five decisional roles (active, semi-active, collaborative, semi-passive, passive), slightly modified for use in dental settings. A second set of cards was used to identify perceived decisional role. Rationale for choice of preferred role was recorded verbatim. Results The Control Preferences Scale was found to be transferable to dental settings. All patients in the sample had identifiable preferences regarding their role in treatment decision-making. A collaborative decisional role, with patient and dentist equally sharing responsibility for decision-making, was most popular at both sites. However, patients at both sites typically perceived themselves as attaining a passive role in treatment decisions. Lack of knowledge about dentistry and trust in the dentist were reported contributors to a passive decisional role preference, whilst those with more active role preferences gave rationales consistent with a consumerist stance. Conclusions This exploratory study's findings suggest that dental patients have distinct preferences in relation to treatment decision-making role and that these may not always be met during consultations with their dentist. The Control Preferences Scale appears to be appropriate for use in dental settings.

Exploring dental patients' preferred roles in treatment decision-making - a novel approach.

To assess the transferability of the Control Preferences Scale to dental settings and to explore patients' preferred and perceived roles in dental treatment decision-making. A convenience sample of 40 patients, 20 recruited from the University Dental Hospital of Manchester and 20 from a general dental practice in Cheshire. A cross-sectional survey, using the Control Preferences Scale, a set of sort cards outlining five decisional roles (active, semi-active, collaborative, semi-passive, passive), slightly modified for use in dental settings. A second set of cards was used to identify perceived decisional role. Rationale for choice of preferred role was recorded verbatim. The Control Preferences Scale was found to be transferable to dental settings. All patients in the sample had identifiable preferences regarding their role in treatment decision-making. A collaborative decisional role, with patient and dentist equally sharing responsibility for decision-making, was most popular at both sites. However, patients at both sites typically perceived themselves as attaining a passive role in treatment decisions. Lack of knowledge about dentistry and trust in the dentist were reported contributors to a passive decisional role preference, whilst those with more active role preferences gave rationales consistent with a consumerist stance. This exploratory study's findings suggest that dental patients have distinct preferences in relation to treatment decision-making role and that these may not always be met during consultations with their dentist. The Control Preferences Scale appears to be appropriate for use in dental settings.

Are patients' decision-making preferences being met?

To investigate the information and decision-making expectations of general practice patients during real life consultations. Post-consultation, quantitative patient preference and enablement questionnaire. Patients attending for routine appointments in general practice surgeries in Oxfordshire, UK. Thirteen Oxfordshire general practitioners (GPs) volunteered to take part and a total of 171 patients completed and returned the questionnaire. Between a quarter and one-third of patients reported receiving less information than they desired, particularly in relation to the risks and benefits of medical treatments. Patients who preferred the doctor to make decisions for them (35%), were more likely to have their preferences met (64%) compared with patients wishing to share decisions (47%) or make their own (18%) who were less likely to achieve this role (52 and 41%, respectively). However, it could not be demonstrated unequivocally that these differences were statistically significant. In total, 61% of patients perceived that they achieved their preferred decision-making role. No significant differences were found in post-consultation enablement scores between any of the decision preference groups. Patients' assessments indicated that some doctors were more successful at achieving congruence than others. The decision-making preferences of general practice patients tend to vary. However, there was a substantial mismatch between the stated preferences of patients for the role they wanted to have in decision-making and what they felt actually took place in their consultation. Therefore, it remains a challenge for doctors to match their consultation style to the decision-making preferences of individual patients.

Decisional regret and quality of life after participating in medical decision-making for early-stage prostate cancer.

To determine the effect of men's reported levels of involvement in medical decision-making and quality of life (QoL) on their levels of decisional regret after definitive treatment. Men referred to a hospital-based resource centre completed QoL and decisional-regret measures after definitive treatment for localized prostate cancer. Data from these questionnaires were linked with a previous study conducted to determine if providing individualized information to men newly diagnosed with prostate cancer would lower their levels of psychological distress and enable them to become more active participants in treatment decision-making. The preferred role in medical decision-making and QoL had previously been measured at the time of diagnosis and the assumed role at 4 months after the definitive treatment decision. This postal survey was conducted approximately 18 months after diagnosis. Of 74 men, 67 (91%) responded; the mean (sd) time since definitive treatment was 10.3 (4.7) months and the mean age of the men 62.5 (6.9) years. Radical prostatectomy was the most frequent treatment (72%). Most (94%) patients participated in medical decision-making either actively or collaboratively and did not regret their treatment choice. The type of definitive treatment received had no effect on decisional regret; patients' QoL scores were similar to the levels before treatment. Levels of sexual function were significantly lower after definitive treatment, but urinary incontinence was not significantly affected. Men who had neoadjuvant hormone therapy reported having significantly more treatment-related symptoms. There is no evidence that providing information to facilitate participation in medical decision-making causes decisional regret or psychological distress within the first year after definitive treatment. A longitudinal follow-up of these patients is required to adequately assess the long-term effects of treatment on QoL and decisional regret.