1 Supplement. Recommendations on Shared Decision Making For Prostate Cancer Screening: Review of the Literature

We reviewed published recommendations as to how primary care doctors should implement shared decision-making on prostate cancer screening. We found there to be a pronounced “Goldilocks effect” with recommendations providing either too little information or too much: too little to make an informed decision or so much as to overwhelm patients ’ ability to decide rationally. An example of a recommendation that provides too little information is actually one previously promoted by an author of this recommendation as part of the “ask-tell-ask ” rubric (1), that doctors tell patients that “some men will be helped because [an aggressive cancer is cured] but some men will be harmed [by overtreatment]”. As a second example, the American Cancer Society (ACS) has recommended that “core elements of … information ” provided to patients include the statement that “screening may be associated with a reduction in the risk of dying from prostate cancer ” and “treatment … can lead to urinary, bowel, sexual and other health problems [that] may be significant or minimal, permanent or temporary. ” (2) The clear problem here is the lack of quantification. There are pros and cons to every course of action; rational decision-making is only possible if the degree of benefit and harm can be compared and balanced. This has led to attempts to provide quantitative estimates to patients. The National Cancer institute (NCI), for example, has created an infographic based on USPSTF estimates (3), including information such a