Effective involvement of patients in decisions made about their healthcare has been given major prominence in recent health strategies from both the UK and US governments. This is particularly important for preference-sensitive decisions, such as treatment for localized prostate cancer, where there is a choice of options and a lack of evidence-based consensus as to which is ‘best’. Shared decision-making (SDM) encompasses the provision of unbiased information concerning the benefits and adverse effects of treatment choices together with tools that patients can use to apply their individual values to different outcomes [1]. A relevant example would be the trading off of preservation of sexual function against greater risk of cancer death in choosing between active surveillance and radical prostatectomy; an SDM tool for use in this situation has recently been disseminated in the UK [2].

Increasing understanding of how to implement effective SDM to improve overall outcome and reduce regret is therefore of importance [3]. Involvement of the partner is particularly relevant for localized prostate cancer given the negative effect of treatment-related sexual dysfunction and incontinence on the wellbeing of both the man and his relationships. The authors of this paper [4] should be commended for using rigorous mixed methodology to first identify common themes regarding clinician–patient–partner interaction by a qualitative approach, and then to use these data to construct a quantitative questionnaire. The highlighted results were that nearly all the partners had frequent cancer-focused discussions with the patient and that 80% felt involved by the clinician regarding treatment decisions. Inevitably there remain a number of questions that perhaps limit the practical usefulness of the findings. I am unsure from the text whether an SDM model of consultation was being practised; recruitment from urology clinics, as pointed out by the authors, may imply that the treatment decision had already been made. The clinician’s views were not collected, nor were those of the few partners who did not attend consultations. It would also have been useful to get the patients to rate their perception of partner involvement for validation of the survey results. Finally, the authors acknowledge that there were no data concerning the benefit of partner involvement in terms of patient decision satisfaction.

How will it change practice? Clinicians generally understand the need to involve the people who accompany patients to consultations balanced with the need to maintain confidentiality and preserve patient autonomy. This paper will further encourage that involvement. There are however perhaps greater challenges on the road to true SDM, particularly the need for clinicians from all specialties to present the benefits and harms of different options in a balanced and evidenced-based way.


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