PubMed · 15515255
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Viv Wright. 2004. Flawed choices.. https://pubmed.ncbi.nlm.nih.gov/15515255/
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This paper examines how consumer information is related to attempts to improve quality of healthcare in England and Germany, both being non-market systems. The paper traces the changes in policy between the first and second electoral terms of the respective 'third way' governments. Both systems are attempting to give consumers more information. But the question is how that information can be used. A degree of convergence can be observed concerning the amount of choice permitted to consumers. In the case of England, the amount of choice consumers have is gradually increasing, while in Germany, attempts are being made to restrict the wide choice of providers in order to cap expenditure.
BACKGROUND: Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer. METHODS: Document development steps included preparing an evidence-based DA in standard medical parlance, iteratively translating it to emphasize shared decision making and plain language in three formats (booklet, Internet, and audio-tape). Scientific review of medical content was integrated with expert health literacy review of document structure and design. Formative evaluation methods included focus groups (n = 4) and survey of a new sample of men newly diagnosed with prostate cancer (n = 60), compared with historical controls (n = 184). RESULTS: A transparent description of the development process and design elements is reported. Formative evaluation among newly diagnosed prostate cancer patients found the DA to be clear and useful in reaching a decision. Newly diagnosed patients reported more discussions with doctors about treatment options, and showed increases in knowledge of side effects of radiation therapy. CONCLUSION: The plain language DA presenting medical evidence in text and numerical formats appears acceptable and useful in decision-making about localized prostate cancer treatment. Further testing should evaluate the impact of all three media on decisions made and quality of life in the survivorship period, especially among very low literacy men.