Prostate cancer and “clever by half”

BJU Int. 2010 Feb 11. [Epub ahead of print]

Development of a scale to assess patient misperceptions about treatment choices for localized prostate cancer.

Beydoun HA, Mohan R, Beydoun MA, Davis J, Lance R, Schellhammer P.

Graduate Program in Public Health, Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.

Study Type – Prevalence (case series) Level of Evidence 4 OBJECTIVES To develop a questionnaire to assess a patient’s knowledge of his cancer, understanding of treatment choices, and judgement of his survival (KUJ) with and without treatment, as treatment for localized prostate cancer (LPC) can lead to urinary, sexual and bowel side-effects and might not improve survival in 75% of patients. PATIENTS AND METHODS Although >90% of patients in the USA are diagnosed with LPC, approximately 94% of them choose treatment, such that newly diagnosed patients need individualized counselling to address misperceptions about the management of LPC. The internal consistency of an 18-item KUJ scale was evaluated among 184 patients recently diagnosed with LPC at a major urology practice. Principal-component analyses were applied for computing a KUJ index. Logistic regression modelling was used to identify predictors of the KUJ index. RESULTS Cronbach’s alpha for the KUJ scale was 0.76. Nearly half of the patients provided incorrect answers to most KUJ items. Of the patients, 68% had an income of >US$50 000 and 90% had at least high (or secondary) school literacy level. Quality-of-life measures suggested that most patients were physically, mentally and socially healthy. Higher education, income and functional capacity were associated with worse KUJ. CONCLUSION The KUJ scale is internally consistent and clinicians can use it to identify the educational needs of patients with LPC before treatment selection. Overall, patients who were socioeconomically disadvantaged and those with physical ailments were better informed about the diagnosis, treatment options and prognosis of prostate cancer.

PMID: 20151969 [PubMed – as supplied by publisher]

I get this better than you would ever imagine. Other M.D.’s will get it also. Now… what I am about to comment on may make some of my readers feel I am being insensitive or overly pigeon-holing a particular patient population. I call them my “know it alls”, or my “clever by half “, or my “go it alone”  or my “internet guy, or as my mother would say, “a little knowledge is a dangerous thing”  types. Most of the above are upper income and educated and feel that the doctor they find themselves in front of are biased in one way or another. And just as Jesus could not be the savior and be from a little town of Nazareth and “are you not the son of Joseph?” there is no way a doctor from this type of patient’s home town could compete with something or someone he has read about on the internet.

It is my feeling that this type or class of patient often skips the educational part of the decision and jumps right to “where is the best” place to go. It may very well be the right decison, it may not be, but they spend more of their time making arrangnements for the best(which may or may not be) than understanding the disease and what is necessary for them.

For years I’d tell patients that the C.E.O. type patient (a take charge aggressive mindset) usually chose surgery- a “get it out type” and that the thinking hesitant and “avoid risk but have my cake and eat it too type” will choose radiation. I’d ask, “who are you?” Alot of what people decide to do depends on their personallity and situation in life and the ability to “go elsewher.”

I have said in my book that probalbly the smartest patient is the one that comes down from the mountains and simply asks,”You are the doctor. What do you recommend?” If you have done your homework on your doctor and trust him or her, this is a very good way to go. Or do your research, find out who you think is the “best” for what you have decided and run that by your doctor. If you have chosen a particular “robot guy”,  you doctor may have the inside skinny as to if he is really the best or not.

I have found that the upper class and educated more often “go it alone” and are “clever by half.” Often they get the diagnosis and never return because they know what’s best.

That is what is happening here. The lower socioeconomic and less educated, ask and listen; the other are too fancy for their own good.

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