Purpose: To compare the impact of a plain language versus a higher reading level decision aid for localized prostate cancer on patients’ knowledge, preference for shared decision making, perceived patient-physician communication, and treatment choice.
Methods: 1015 men were recruited from 4 VA hospitals, either before or after receiving a prostate biopsy because of suspicion of prostate cancer. Men were randomized to either receive a plain language decision aid (7th grade reading level) or a higher reading level decision aid (12th grade reading level). Participants completed measures at three time periods: biopsy (Time 1), immediately before receiving their cancer diagnosis (Time 2), and one week following diagnosis (Time 3). Only those patients with a positive biopsy result indicating localized prostate cancer (PSA<20, Gleason score of 6 or 7) were eligible to complete Time 2 and 3 measures (N = 335).
Results: Participants receiving the plain language decision aid showed higher knowledge at Time 2 (64% correct vs. 57% correct; F=11.7, p=0.001), were more interested in shared decision making at Time 2 (2.53 vs. 2.35, F=6.37, p<0.02), and were more interested in active surveillance prior to talking with their doctor (Time 2: 43.0% vs. 30.6%, p<0.05) compared with those receiving a higher reading level decision aid. There were no differences between groups in treatment preferences after speaking with their doctor (Time 3) or the treatment they actually received (determined by medical record review).
Conclusions: Although developing plain language decision aids is an expensive and time-consuming task, it has significant impact on patients’ initial treatment preferences and key components of the decision making process. Between the time that the patient read the decision aid and when he found out his diagnosis, those with the plain language decision aid were more interested in shared decision making and in less invasive treatments. They also had a more positive perception of the decision aid. These results suggest that using plain language principles in designing decision aids has important implications for medical decision making.