Men's Theories About Benign Prostatic Hyperplasia and Prostate Cancer Following a Benign Prostatic Hyperplasia Decision Aid


  • None of the authors has any known conflict of interest or any financial ties to the funding agencies or the Foundation for Informed Medical Decision-Making, or Health Dialog.

  • Presented at the 2nd International Shared Decision Making meeting, Swansea, Wales, September 2–4, 2003.

Address correspondence and requests for reprints to Dr. Margaret Holmes-Rovner: Department of Medicine and Center for Ethics, College of Human Medicine, Michigan State University, C203 E. Fee Hall, East Lansing, MI 48824 (e-mail:


Objective: To use qualitative methods to explore audiotape evidence of unanticipated confusion between benign prostatic hyperplasia (BPH) and prostate cancer in using a videotape BPH treatment decision aid (DA).

Design: Qualitative analysis of semi-structured interviews and surveys originally collected to study men's interpretation of a DA.

Setting and Participants: Community sample of college and noncollege educated African American and white men (age≥50; n=188).

Measures: Transcript analysis identified themes in men's comments about BPH and cancer. Surveys measured BPH general and prostate cancer-specific knowledge, literacy (Short Test of Functional Health Literacy in Adults), BPH symptoms, and demographics.

Results: In transcript analysis, 18/188 men spontaneously talked about BPH and cancer as being related to each other, despite explicit statements to the contrary in the video. Survey data suggest that up to 126/188 men (67%) persisted in misconceptions even after viewing the DA video. Three themes were identified in the transcripts: (1) BPH and cancer are equated, (2) BPH surgery is for the purpose of removing cancer, and (3) BPH leads to cancer.

Conclusions: Overall knowledge increases with DA use may mask incorrect theories of disease process. Further research should identify decision support designs and clinical counseling strategies to address persistence of beliefs contrary to new information presented in evidence-based DAs.