Shared decision-making: Clarifying roles in prostate cancer care

In a recent interview, Timothy J. Daskivich, MD, MSHPM, and Nadine Friedrich, MD, explored how physicians can balance their own perspectives with patient values in the shared decision-making process, particularly in the context of localized prostate cancer.¹

Daskivich explained that shared decision-making can be broken into 3 domains: patient preferences, physician preferences, and clinical evidence. He emphasized that physicians must provide clear recommendations while underscoring that treatment choices should ultimately be guided by patient values. This involves outlining available options, explaining which values and outcomes each option prioritizes, and then circling back to align these with the patient’s individual priorities.

He also addressed the common patient question—“What would you do, doctor?”—noting that about a quarter of patients pose it. Although it is appropriate for physicians to share their personal recommendation, Daskivich stressed the importance of clarifying that their advice reflects their own values and risk tolerances, which may not align with the patient’s. In this way, the physician’s opinion becomes a reference point rather than a directive.

Friedrich highlighted the broader applicability of this structured, topic-mapped framework for shared decision-making. Although the study focused on prostate cancer, she noted that the principles extend to other cancers and chronic illnesses where treatment options are preference-sensitive. What changes across conditions, she explained, is the specific framing and language used to contextualize risks and benefits.

Daskivich agreed, pointing out that prostate cancer is a strong example of shared decision-making in practice because treatments profoundly affect quality of life whereas survival outcomes vary. Still, the same dynamics—multiple evidence-based options, trade-offs in outcomes, and the central role of patient values—apply to many disease states. Both experts concluded that although the details shift by condition, the core structure of patient-centered decision-making remains constant.

REFERENCE

1. Friedrich NA, Kokorowski P, Luu M, et al. Topic mapping to inform content to discuss in shared decision-making for prostate cancer. Urology. 2025 May 28:S0090-4295(25)00511-4. doi:10.1016/j.urology.2025.05.053