RANOMIZED TRIAL OF THE SDP FOR PATIENTS WITH BPH

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About 400,000 men undergo prostatectomy annually in the United States for benign prostatic hyperplasia: a much greater number have BPH symptoms but do not have surgery in a given year. To educate men about BPH and the treatment alternatives available, and to facilitate patient participation in the decision-making process, the investigators have developed an interactive educational program, both computer and videodisc based, called the Shared Decision-Making Procedure (SDP). The SDP is used as a supplement to traditional office-based decision-making. The SDP has already been determined to be acceptable to both patients and urologists in a 4 site pilot study. The proposed project is an efficacy study of the SDP, to take place in two urologic practices in Group Health Co-operative of Puget Sound. After a period of baseline data collection, patients presenting with symptomatic BPH but without pressing indications for surgery will be randomized to either the SDP or a control group; the latter patients will receive a minimal educational intervention (a brochure). Study outcomes will determine whether SDP use leads to: 1. Improved health and well being; 2. Better knowledge about BPH and its treatments; 3. Greater patient willingness to participate in treatment decisions: 4. A change in treatment decisions; 5. Greater patient satisfaction with both the decisions made and the process of decision-making. 6. More weight in decision-making placed on patient preferences. To provide adequate power for the study, 200 men will be enrolled in the baseline period and 400 men will subsequently be randomized. All men will be followed for at least nine months after enrolling. The project duration will be three years. Although the SDP approach has great face validity and is readily generalized to other medical problems besides BPH, a formal test of its efficacy in actual practice is essential.