Kevin with eleven minutes is the best description of shared decision making I have read, and I recognize him from a different corridor. I do the anesthesia version of that conversation every working day, with someone who is fasting, frightened, already in a gown, and being asked to weigh risks they have never once had reason to think about. Several thousand of those later, here is what I think the phrase actually names: it is a transfer of liability unless somebody does the work of translating it into a decision a human being can make. What makes it real, in my experience, is telling the person plainly what I would weigh if it were my own body, and then leaving room for them to disagree with me. And your point about the trend beating the single number is the same lesson wearing different clothes. One value in isolation is not information about a person. It is a data point looking for a story, and eleven minutes is not enough time to find the right one.
As someone living in a new normal of active surveillance of prostate cancer, I urge men in their 40s to become informed. I knew my PSA in my 40s, 50s, and 60s. My PSA rose in my late 60s, but no cancer was found. Now it has been. Knowledge is power.
Here’s what I don’t understand. If over-treating is a problem in groups that are not likely to be diagnosed with prostate cancer, would it not also be a problem in groups likely to be diagnosed with prostate cancer?
it seems like the reasoning is that benefit of testing is greater than the harm of overtreating, but not that much greater, so in low risk groups the NHS would rather save the cost of the test.
A wonderful description shit show prostate cancer testing is, and a really useful conclusion. Now…how to get men interested in this soon enough so they can make educated decisions.
Kevin with eleven minutes is the best description of shared decision making I have read, and I recognize him from a different corridor. I do the anesthesia version of that conversation every working day, with someone who is fasting, frightened, already in a gown, and being asked to weigh risks they have never once had reason to think about. Several thousand of those later, here is what I think the phrase actually names: it is a transfer of liability unless somebody does the work of translating it into a decision a human being can make. What makes it real, in my experience, is telling the person plainly what I would weigh if it were my own body, and then leaving room for them to disagree with me. And your point about the trend beating the single number is the same lesson wearing different clothes. One value in isolation is not information about a person. It is a data point looking for a story, and eleven minutes is not enough time to find the right one.
I'm the man in your last sentence or, as the UK decision makers call us, "the minimal benefit to testing" 🤪
As someone living in a new normal of active surveillance of prostate cancer, I urge men in their 40s to become informed. I knew my PSA in my 40s, 50s, and 60s. My PSA rose in my late 60s, but no cancer was found. Now it has been. Knowledge is power.
Here’s what I don’t understand. If over-treating is a problem in groups that are not likely to be diagnosed with prostate cancer, would it not also be a problem in groups likely to be diagnosed with prostate cancer?
it seems like the reasoning is that benefit of testing is greater than the harm of overtreating, but not that much greater, so in low risk groups the NHS would rather save the cost of the test.
A wonderful description shit show prostate cancer testing is, and a really useful conclusion. Now…how to get men interested in this soon enough so they can make educated decisions.