In 1960, Harriet Gudenburr embarked on a nursing career that would span more than five decades and would touch the lives of hundreds of patients. In September 2011, Harriet retired from her position at Allegheny General Hospital where she had established the Informed Decision Making program at the hospital's Breast Care Center. In partnership with the Informed Medical Decisions Foundation, Harriet and her team ensured patients were provided shared decision making (SDM) opportunities on their breast cancer journey.
The U.S. Preventive Services Task Force (USPSTF) published their final recommendation on PSA testing in an Annals of Internal Medicine article this week. The panel advises against PSA-based prostate cancer screening for men of all ages. The rationale for this recommendation is based on the panel’s moderate certainty that the potential harms outweigh the benefits for all age groups. Based on clinical evidence from two large randomized trials evaluated by the panel, at most 1 out of 1,000 men screened will avoid dying from prostate cancer over 10 years, while many more men will be left with permanent disabilities from their treatment, such as incontinence (18 in 1,000) or impotence (29 in 1,000).
Good quality health information is essential for greater patient involvement in healthcare. Patients and the public require information that is timely, relevant, reliable and easy to understand. This is an essential component of any strategy to promote health literacy, self-care, choice- shared decision-making, medication adherence and self-management of chronic disease. Patients have many decisions to make about their healthcare and, like all decision-makers, they require information to inform their choices. Reliable information is also essential to help patients understand their health problems and how to deal with them.
The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources.