Improving the communication of benefits and harms of treatment strategies: decision AIDS for localized prostate cancer treatment decisions.

Treatment decisions for localized prostate cancer are preference sensitive. The optimal treatment strategy is unknown, and active treatment is not always necessary. Choosing among the various options involves tradeoffs between cancer control and complications that affect quality of life. A shared decision-making process, particularly facilitated by a decision aid, can help a patient make an informed decision that is concordant with his values and preferences. Studies have shown that informed patients are more willing to forego aggressive treatment, but much work is needed to develop and evaluate high-quality decision aids that accurately portray active surveillance. The research agenda for decision aids includes evaluating content elements and format, timing and setting for delivery, the quality of the decision-making process, and the effects of decision support on treatment selection (which will occur repeatedly for men opting for active surveillance) and quality of life.