23 Dec, 10 | by BMJ Group
My longstanding interests in US health disparities, doctor patient interactions, and prostate cancer mortality made the 477th Salzburg Global Seminar of profound interest to me. It had a great impact on my thinking as a sociologist. The seminar enlightened me about problems with the quality of health communications and processes of decision making that may result in less than desirable health outcomes. It also informed me about important pathways to the way forward.
In 2009 there were 192,280 new prostate cancer cases in the US and 27,360 deaths; this form of cancer represents 25% of new cancer cases and 9% of cancer deaths (1). Although prostate cancer death rates have fallen since 1990, between 2001 and 2005, the incidence of prostate cancer remained highest among African-Americans (compared to white and other men). Mortality rates were also twice as high for black men (1). This reality has generated considerable concern and anxiety among men in the US and around the globe. As a result, many men make decisions that lead to considerable suffering and “potential harm” ((Gigerenzer and Gray 2011, in press) in the forms of decreased quality of life as a result of uninformed decisions regarding prostate cancer screening and treatment regimens. The challenge is how to get more men and their doctors to engage in informed decision making.
Although I had heard about the concerns about the validity of PSA (prostate specific antigen) screening for prostate cancer, I was less aware that prostate cancer screening programs may, in some cases, be more harmful than helpful, especially for patients (with non-progressive forms of cancer) who have been persuaded that PSA screening is both benign and beneficial (Gigerenzer and Gray 2011, in press). Well intended yet misleading (or misunderstood) health communications actually contribute to health problems. Given the claims made to men of African descent about their raised risk of prostate cancer, many men who are likely to die from other causes feel pressured to make decisions that inevitably and unnecessarily affect their quality of life. With such potentially dire consequences associated with screening (such as the possibility of false positive results and unnecessary biopsies) and surgery, men have to be empowered to make informed decisions that allow them to weigh the choices they make that are likely to affect their personal (possible incontinence) and family lives (possible impotence). They have to know that, in many cases, watchful waiting is a viable alternative to screening and surgery.
The seminar provided insight about how to help address this very large set of issues. The work of the Foundation for Informed Medical Decision Making provided seminar participants with tools that can be used to critique and ultimately improve health communications and to provide men with information that will help them to make better health decisions about the risks and benefits associated with watchful waiting, screening, and surgery.
I am motivated to help improve health literacy, to help enhance shared communication between physicians and patients, and to promote informed and shared medical decision making.
Bruce H Wade is associate professor at the Department of Sociology and Anthropology, Spelman College, Atlanta, Georgia, USA.