Margaret Holmes-rovner | Michigan State University (original) (raw)

Papers by Margaret Holmes-rovner

Journal of Statistical Planning and Inference, 1999

Progress in Cardiovascular Diseases, 1994

BMJ (Clinical research ed.), Jan 17, 2001

BMC medical informatics and decision making, 2005

Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision mak... more Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer. Document development steps included preparing an evidence-based DA in standard medical parlance, iteratively translating it to emphasize shared decision making and plain language in three formats (booklet, Internet, and audio-tape). Scientific review of medical content was integrated with expert health literacy review of document structure and design. Formative evaluation methods included focus groups (n = 4) and survey of a new sample of men new...

BMC medical informatics and decision making, Jan 16, 2004

Prospective users of preventive therapies often must evaluate complex information about therapeut... more Prospective users of preventive therapies often must evaluate complex information about therapeutic risks and benefits. The purpose of this study was to evaluate the effect of relative and absolute risk information on patient decision-making in scenarios typical of health information for patients. Factorial experiments within a telephone survey of the Michigan adult, non-institutionalized, English-speaking population. Average interview lasted 23 minutes. Subjects and sample design: 952 randomly selected adults within a random-digit dial sample of Michigan households. Completion rate was 54.3%. When presented hypothetical information regarding additional risks of breast cancer from a medication to prevent a bone disease, respondents reduced their willingness to recommend a female friend take the medication compared to the baseline rate (66.8% = yes). The decrease was significantly greater with relative risk information. Additional benefit information regarding preventing heart diseas...

Medical care, 2002

With publication of The Belmont Report concerning ethical principles, informed consent gained exp... more With publication of The Belmont Report concerning ethical principles, informed consent gained explicit guidelines for the protection of human subjects of research. However, there is still little evidence about how well informed consent works to assist patients to reach informed decisions about research participation. To review behavioral decision theory and research to identify implications for informed consent. Traditional literature review and hand search of literature were used. Psychological research on biases and heuristics identifies cognitive biases in information processing (selection and interpretation of risks and benefits) that have implications for improving the informing process. A growing literature on patient decision aids provides evidence for the feasibility of more fully informing patients, and includes examples of "debiasing" procedures (to improve information comprehension and consent). Informing and consenting involve conceptually different challenges ...

BMC family practice, 2006

Publication of results from the Women's Health Initiative study in July 2002 was a landmark e... more Publication of results from the Women's Health Initiative study in July 2002 was a landmark event in biomedical science related to postmenopausal women. The purpose of this study was to describe the impact of new hormone therapy recommendations on patients' attitudes and decision-making in a primary care practice. A questionnaire including structured and open-ended questions was administered in a family practice office waiting room from August through October 2003. Rationale for taking or not taking hormone therapy was specifically sought. Women 50-70 years old attending for office visits were invited to participate. Data were analyzed qualitatively and with descriptive statistics. Chart review provided medication use rates for the entire practice cohort of which the sample was a subset. Respondents (n = 127) were predominantly white and well educated, and were taking hormone therapy at a higher rate (38%) than the overall rate (26%) for women of the same age range in this p...

Purpose: In a study of men undergoing biopsy and treatment for prostate cancer, we examined wheth... more Purpose: In a study of men undergoing biopsy and treatment for prostate cancer, we examined whether pre-existing Cancer Anxiety and preferences for active medical interventions (Action Bias) influence treatment preferences and decisions. We used an established measure of Anxiety and a new measure of Action Bias to explore how these pre-existing individual differences impact decisions at different points in the decision-making process. Method: 1015 men, with suspicion of prostate cancer, were recruited from 4 VA hospitals at the time of biopsy, as a part of a study of prostate cancer decision aids (DA). Prior to reading a DA, patients completed a questionnaire that assessed their prostate cancer anxiety (Memorial Anxiety Scale for Prostate Cancer), and their bias toward active treatment options (e.g. “Doing everything to fight cancer is the right choice”). These baseline measures were used to predict (1) treatment preferences expressed after reading the DA, but prior to diagnosis, (2...

Purpose: To determine the relationship between patient literacy level and anxiety, knowledge, pre... more Purpose: To determine the relationship between patient literacy level and anxiety, knowledge, preference for shared decision making, perceived patient-physician communication, and treatment choice. Method: 1015 men undergoing a prostate biopsy were recruited from 4 VA hospitals either before or after receiving their biopsy, as a part of a study examining prostate cancer decision aids. Participants completed measures at 3 timepoints: biopsy (Time 1), immediately before receiving their cancer diagnosis (Time 2), and one week post-diagnosis (Time 3). Only patients with positive biopsy results indicating localized cancer were eligible to complete Time 2 and 3 measures (N=335). Literacy was measured using the Rapid Estimates of Adult Literacy in Medicine (REALM). Result: 72.6% of participants were classified as having adequate literacy (≥9th grade reading level), while 27.4% were classified as having inadequate literacy (≤8th grade reading level). Participants with inadequate literacy ha...

Purpose: To compare the impact of a plain language versus a higher reading level decision aid for... more Purpose: To compare the impact of a plain language versus a higher reading level decision aid for localized prostate cancer on patients’ knowledge, preference for shared decision making, perceived patient-physician communication, and treatment choice. Methods: 1015 men were recruited from 4 VA hospitals, either before or after receiving a prostate biopsy because of suspicion of prostate cancer. Men were randomized to either receive a plain language decision aid (7th grade reading level) or a higher reading level decision aid (12th grade reading level). Participants completed measures at three time periods: biopsy (Time 1), immediately before receiving their cancer diagnosis (Time 2), and one week following diagnosis (Time 3). Only those patients with a positive biopsy result indicating localized prostate cancer (PSA<20, Gleason score of 6 or 7) were eligible to complete Time 2 and 3 measures (N = 335). Results: Participants receiving the plain language decision aid showed higher ...

Purpose: Research has shown that racial minorities often have different treatment preferences tha... more Purpose: Research has shown that racial minorities often have different treatment preferences than Whites. One question is whether this is the result of knowledge deficits, differences in literacy or numeracy levels, or any of a number of factors. In the present research, men receiving prostate cancer biopsies were given either a low or high literacy decision aid (DA), and then treatment preferences were assessed. The purpose of the present research was to explore racial differences in treatment preferences following exposure to low versus high literacy DAs. Method: 1023 men from four VA hospitals were recruited at their prostate cancer biopsy appointment; 77% of the participants were White, and 23% were non-White (of which 92% were African American). At Time 1 participants were randomly assigned to receive either a low or high literacy prostate cancer decision aid. Literacy (using the REALM), and subjective numeracy were also assessed. At Time 2, which occurred after participants r...

Purpose: The current study tested whether having access to a decision aid prior to physician cons... more Purpose: The current study tested whether having access to a decision aid prior to physician consultation resulted in stable treatment preferences. Method: 1,023 patients presenting to one of four VAs for a prostate cancer biopsy completed baseline measures and were randomized to receive 1 of 2 decision aids. 244 patients diagnosed with prostate cancer completed 2 additional surveys (73% response rate). Time 2 occurred after they had read their decision aid but just prior to receiving their diagnosis. Patients were re-interviewed 1 week later (Time 3), which was following their diagnosis. Electronic medical records were used to determine the treatment patients received. Surveys included measures of treatment preference, literacy, patients’ perceptions of their physicians recommendations and their communication with their physician. Result: Patients’ preferences for treatment from before they saw their doctor (Time 2) and 1 week later (Time 3) changed significantly: 39% of patients w...

The American journal of managed care, 2006

To investigate the pattern of postdischarge evidence-based outpatient medication use and its impa... more To investigate the pattern of postdischarge evidence-based outpatient medication use and its impact on subsequent hospital readmissions in post-acute coronary syndrome (ACS) patients. Prospective observational study. A telephone survey was conducted to collect information from discharge to 8 months after discharge for 433 patients hospitalized with a primary diagnosis of ACS in 5 mid-Michigan hospitals. The survey data were then merged with chart review data from the initial hospitalization. We first conducted a longitudinal descriptive analysis of the utilization patterns of patient self-reported medication use from discharge to the 8-month survey. Then, multivariable logit analysis was used to estimate the effect of post-ACS medication use on self-reported hospital readmission at 3 months and 8 months after discharge. Propensity score matching was used to counter the possible bias induced by self-selection of outpatient medication use. The pattern of outpatient medication use was ...

Patient Education and Counseling, 2003

The objective of this project was to analyze newspaper coverage of the January 2000 meta-analysis... more The objective of this project was to analyze newspaper coverage of the January 2000 meta-analysis by Gotzsche and Olsen, “Is screening for breast cancer with mammography justified?” [Lancet 355 (2000) 129]. A content analysis was performed on a comprehensive set of newspaper clippings from the UK during the 2 weeks following publication of the Lancet article. The original authors were

International Journal for Quality in Health Care, 2014

Patient Education and Counseling, 2011

Develop a system of practice tools and procedures to prompt shared decision making in primary car... more Develop a system of practice tools and procedures to prompt shared decision making in primary care. SDM-GRIP (Shared Decision Making Guidance Reminders in Practice) was developed for suspected stable coronary artery disease (CAD), prior to the percutaneous coronary intervention (PCI) decision. Program evaluation of SDM-GRIP components: Grand Rounds, provider training (communication skills and clinical evidence), decision aid (DA), patient group visit, encounter decision guide (EDG), SDM provider visit. Participation-Physician training=73% (21/29); patient group visits=25% of patients with diagnosis of CAD contacted (43/168). SDM visits=16% (27/168). Among SDM visit pairs, 82% of responding providers reported using the EDG in SDM encounters. Patients valued the SDM-GRIP program, and wanted to discuss comparative effectiveness information with a cardiologist. SDM visits were routinely reimbursed. Program elements were well received and logistically feasible. However, recruitment to an extra educational group visit was low. Future implementation will move SDM-GRIP to the point of routine ordering of non-emergent stress tests to retain pre-decision timing of PCI and to improve coordination of care, with SDM tools available across primary care and cardiology. Guidance prompts and provider training appear feasible. Implementation at stress testing requires further investigation.

Research in Nursing & Health, 1997

Patient Education and Counseling, 2003

Patient Education and Counseling, 2006

As part of a study of men&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more As part of a study of men&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s responses to a videotape decision aid [Rovner DR, Wills CE, Bonham V, Williams G, Lillie J, Kelly-Blake K, Williams MV, Holmes-Rovner M. Decision aids for benign prostatic hyperplasia: applicability across race and education. Med Decis Making 2004;24:359-66], preferences for BPH treatment options were assessed. One hundred and sixty men stratified by race and education completed a semi-structured interview that included assessments of treatment preferences. Most men initially and ultimately favored watchful waiting over other options, and 56.6% never changed their preference rank orders while viewing the videotape. BPH severity in context of treatment risk avoidance, efficacy, and expert opinion factors were frequently cited reasons for preference orders. Lesser education was associated with higher likelihood of changing preferences (r = -.30, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), and percent increase in BPH knowledge pre- to post-videotape was weakly associated with fewer non-dominant preference shifts (r = -.19, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Conservatism regarding BPH treatment is moderated by context-specific factors, including new information. Counseling in a provider-patient partnership model should address both sources of variance in men&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s treatment preferences.

Journal of Statistical Planning and Inference, 1999

Progress in Cardiovascular Diseases, 1994

BMJ (Clinical research ed.), Jan 17, 2001

BMC medical informatics and decision making, 2005

Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision mak... more Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer. Document development steps included preparing an evidence-based DA in standard medical parlance, iteratively translating it to emphasize shared decision making and plain language in three formats (booklet, Internet, and audio-tape). Scientific review of medical content was integrated with expert health literacy review of document structure and design. Formative evaluation methods included focus groups (n = 4) and survey of a new sample of men new...

BMC medical informatics and decision making, Jan 16, 2004

Prospective users of preventive therapies often must evaluate complex information about therapeut... more Prospective users of preventive therapies often must evaluate complex information about therapeutic risks and benefits. The purpose of this study was to evaluate the effect of relative and absolute risk information on patient decision-making in scenarios typical of health information for patients. Factorial experiments within a telephone survey of the Michigan adult, non-institutionalized, English-speaking population. Average interview lasted 23 minutes. Subjects and sample design: 952 randomly selected adults within a random-digit dial sample of Michigan households. Completion rate was 54.3%. When presented hypothetical information regarding additional risks of breast cancer from a medication to prevent a bone disease, respondents reduced their willingness to recommend a female friend take the medication compared to the baseline rate (66.8% = yes). The decrease was significantly greater with relative risk information. Additional benefit information regarding preventing heart diseas...

Medical care, 2002

With publication of The Belmont Report concerning ethical principles, informed consent gained exp... more With publication of The Belmont Report concerning ethical principles, informed consent gained explicit guidelines for the protection of human subjects of research. However, there is still little evidence about how well informed consent works to assist patients to reach informed decisions about research participation. To review behavioral decision theory and research to identify implications for informed consent. Traditional literature review and hand search of literature were used. Psychological research on biases and heuristics identifies cognitive biases in information processing (selection and interpretation of risks and benefits) that have implications for improving the informing process. A growing literature on patient decision aids provides evidence for the feasibility of more fully informing patients, and includes examples of "debiasing" procedures (to improve information comprehension and consent). Informing and consenting involve conceptually different challenges ...

BMC family practice, 2006

Publication of results from the Women's Health Initiative study in July 2002 was a landmark e... more Publication of results from the Women's Health Initiative study in July 2002 was a landmark event in biomedical science related to postmenopausal women. The purpose of this study was to describe the impact of new hormone therapy recommendations on patients' attitudes and decision-making in a primary care practice. A questionnaire including structured and open-ended questions was administered in a family practice office waiting room from August through October 2003. Rationale for taking or not taking hormone therapy was specifically sought. Women 50-70 years old attending for office visits were invited to participate. Data were analyzed qualitatively and with descriptive statistics. Chart review provided medication use rates for the entire practice cohort of which the sample was a subset. Respondents (n = 127) were predominantly white and well educated, and were taking hormone therapy at a higher rate (38%) than the overall rate (26%) for women of the same age range in this p...

Purpose: In a study of men undergoing biopsy and treatment for prostate cancer, we examined wheth... more Purpose: In a study of men undergoing biopsy and treatment for prostate cancer, we examined whether pre-existing Cancer Anxiety and preferences for active medical interventions (Action Bias) influence treatment preferences and decisions. We used an established measure of Anxiety and a new measure of Action Bias to explore how these pre-existing individual differences impact decisions at different points in the decision-making process. Method: 1015 men, with suspicion of prostate cancer, were recruited from 4 VA hospitals at the time of biopsy, as a part of a study of prostate cancer decision aids (DA). Prior to reading a DA, patients completed a questionnaire that assessed their prostate cancer anxiety (Memorial Anxiety Scale for Prostate Cancer), and their bias toward active treatment options (e.g. “Doing everything to fight cancer is the right choice”). These baseline measures were used to predict (1) treatment preferences expressed after reading the DA, but prior to diagnosis, (2...

Purpose: To determine the relationship between patient literacy level and anxiety, knowledge, pre... more Purpose: To determine the relationship between patient literacy level and anxiety, knowledge, preference for shared decision making, perceived patient-physician communication, and treatment choice. Method: 1015 men undergoing a prostate biopsy were recruited from 4 VA hospitals either before or after receiving their biopsy, as a part of a study examining prostate cancer decision aids. Participants completed measures at 3 timepoints: biopsy (Time 1), immediately before receiving their cancer diagnosis (Time 2), and one week post-diagnosis (Time 3). Only patients with positive biopsy results indicating localized cancer were eligible to complete Time 2 and 3 measures (N=335). Literacy was measured using the Rapid Estimates of Adult Literacy in Medicine (REALM). Result: 72.6% of participants were classified as having adequate literacy (≥9th grade reading level), while 27.4% were classified as having inadequate literacy (≤8th grade reading level). Participants with inadequate literacy ha...

Purpose: To compare the impact of a plain language versus a higher reading level decision aid for... more Purpose: To compare the impact of a plain language versus a higher reading level decision aid for localized prostate cancer on patients’ knowledge, preference for shared decision making, perceived patient-physician communication, and treatment choice. Methods: 1015 men were recruited from 4 VA hospitals, either before or after receiving a prostate biopsy because of suspicion of prostate cancer. Men were randomized to either receive a plain language decision aid (7th grade reading level) or a higher reading level decision aid (12th grade reading level). Participants completed measures at three time periods: biopsy (Time 1), immediately before receiving their cancer diagnosis (Time 2), and one week following diagnosis (Time 3). Only those patients with a positive biopsy result indicating localized prostate cancer (PSA<20, Gleason score of 6 or 7) were eligible to complete Time 2 and 3 measures (N = 335). Results: Participants receiving the plain language decision aid showed higher ...

Purpose: Research has shown that racial minorities often have different treatment preferences tha... more Purpose: Research has shown that racial minorities often have different treatment preferences than Whites. One question is whether this is the result of knowledge deficits, differences in literacy or numeracy levels, or any of a number of factors. In the present research, men receiving prostate cancer biopsies were given either a low or high literacy decision aid (DA), and then treatment preferences were assessed. The purpose of the present research was to explore racial differences in treatment preferences following exposure to low versus high literacy DAs. Method: 1023 men from four VA hospitals were recruited at their prostate cancer biopsy appointment; 77% of the participants were White, and 23% were non-White (of which 92% were African American). At Time 1 participants were randomly assigned to receive either a low or high literacy prostate cancer decision aid. Literacy (using the REALM), and subjective numeracy were also assessed. At Time 2, which occurred after participants r...

Purpose: The current study tested whether having access to a decision aid prior to physician cons... more Purpose: The current study tested whether having access to a decision aid prior to physician consultation resulted in stable treatment preferences. Method: 1,023 patients presenting to one of four VAs for a prostate cancer biopsy completed baseline measures and were randomized to receive 1 of 2 decision aids. 244 patients diagnosed with prostate cancer completed 2 additional surveys (73% response rate). Time 2 occurred after they had read their decision aid but just prior to receiving their diagnosis. Patients were re-interviewed 1 week later (Time 3), which was following their diagnosis. Electronic medical records were used to determine the treatment patients received. Surveys included measures of treatment preference, literacy, patients’ perceptions of their physicians recommendations and their communication with their physician. Result: Patients’ preferences for treatment from before they saw their doctor (Time 2) and 1 week later (Time 3) changed significantly: 39% of patients w...

The American journal of managed care, 2006

To investigate the pattern of postdischarge evidence-based outpatient medication use and its impa... more To investigate the pattern of postdischarge evidence-based outpatient medication use and its impact on subsequent hospital readmissions in post-acute coronary syndrome (ACS) patients. Prospective observational study. A telephone survey was conducted to collect information from discharge to 8 months after discharge for 433 patients hospitalized with a primary diagnosis of ACS in 5 mid-Michigan hospitals. The survey data were then merged with chart review data from the initial hospitalization. We first conducted a longitudinal descriptive analysis of the utilization patterns of patient self-reported medication use from discharge to the 8-month survey. Then, multivariable logit analysis was used to estimate the effect of post-ACS medication use on self-reported hospital readmission at 3 months and 8 months after discharge. Propensity score matching was used to counter the possible bias induced by self-selection of outpatient medication use. The pattern of outpatient medication use was ...

Patient Education and Counseling, 2003

The objective of this project was to analyze newspaper coverage of the January 2000 meta-analysis... more The objective of this project was to analyze newspaper coverage of the January 2000 meta-analysis by Gotzsche and Olsen, “Is screening for breast cancer with mammography justified?” [Lancet 355 (2000) 129]. A content analysis was performed on a comprehensive set of newspaper clippings from the UK during the 2 weeks following publication of the Lancet article. The original authors were

International Journal for Quality in Health Care, 2014

Patient Education and Counseling, 2011

Develop a system of practice tools and procedures to prompt shared decision making in primary car... more Develop a system of practice tools and procedures to prompt shared decision making in primary care. SDM-GRIP (Shared Decision Making Guidance Reminders in Practice) was developed for suspected stable coronary artery disease (CAD), prior to the percutaneous coronary intervention (PCI) decision. Program evaluation of SDM-GRIP components: Grand Rounds, provider training (communication skills and clinical evidence), decision aid (DA), patient group visit, encounter decision guide (EDG), SDM provider visit. Participation-Physician training=73% (21/29); patient group visits=25% of patients with diagnosis of CAD contacted (43/168). SDM visits=16% (27/168). Among SDM visit pairs, 82% of responding providers reported using the EDG in SDM encounters. Patients valued the SDM-GRIP program, and wanted to discuss comparative effectiveness information with a cardiologist. SDM visits were routinely reimbursed. Program elements were well received and logistically feasible. However, recruitment to an extra educational group visit was low. Future implementation will move SDM-GRIP to the point of routine ordering of non-emergent stress tests to retain pre-decision timing of PCI and to improve coordination of care, with SDM tools available across primary care and cardiology. Guidance prompts and provider training appear feasible. Implementation at stress testing requires further investigation.

Research in Nursing & Health, 1997

Patient Education and Counseling, 2003

Patient Education and Counseling, 2006

As part of a study of men&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more As part of a study of men&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s responses to a videotape decision aid [Rovner DR, Wills CE, Bonham V, Williams G, Lillie J, Kelly-Blake K, Williams MV, Holmes-Rovner M. Decision aids for benign prostatic hyperplasia: applicability across race and education. Med Decis Making 2004;24:359-66], preferences for BPH treatment options were assessed. One hundred and sixty men stratified by race and education completed a semi-structured interview that included assessments of treatment preferences. Most men initially and ultimately favored watchful waiting over other options, and 56.6% never changed their preference rank orders while viewing the videotape. BPH severity in context of treatment risk avoidance, efficacy, and expert opinion factors were frequently cited reasons for preference orders. Lesser education was associated with higher likelihood of changing preferences (r = -.30, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), and percent increase in BPH knowledge pre- to post-videotape was weakly associated with fewer non-dominant preference shifts (r = -.19, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Conservatism regarding BPH treatment is moderated by context-specific factors, including new information. Counseling in a provider-patient partnership model should address both sources of variance in men&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s treatment preferences.