How Doctors Can Adapt to the Digital Communication Revolution | MedPage Today

The Evolving Doctor-Patient Relationship: A New Paradigm for Prostate Cancer Decision-Making

By IPCSG Newsletter Staff | April 5, 2025

In an era of digital health tools and instant information access, the traditional doctor-patient relationship is undergoing profound changes—particularly for prostate cancer patients navigating complex treatment decisions. A recent opinion piece by Dr. Jeffrey Millstein in MedPage Today highlights how today's patients bring more of their own research to medical consultations, challenging physicians to adapt their communication approach.

The Son-to-Father Advice Problem

Dr. Millstein describes a 60-year-old prostate cancer patient who felt shut down when his surgeon said, "If you were my father, I would tell you to have surgery," despite the patient having alternative ideas he wanted to discuss. While the surgeon was well-meaning, this personal advice effectively ended the conversation, leaving the patient feeling unheard.

This scenario is all too familiar to many prostate cancer patients who have treatment options with similar survival outcomes but different side effect profiles. When personal advice from physicians replaces collaborative discussion, patients may leave with unaddressed concerns.

The Digital Revolution in Patient Information

Gone are the days when "Dr. Google" would elicit eye rolls from physicians. Today's patients have access to powerful digital tools, artificial intelligence chatbots, symptom checkers, wearable devices, and unprecedented healthcare data transparency. Simultaneously, patients have become more comfortable questioning expert opinions in general.

This shift creates both challenges and opportunities for the doctor-patient relationship. Research shows that when patients are actively involved in decision-making, they report better satisfaction with care and improved quality of life outcomes.

A New Model for Shared Decision-Making

Research supports a more collaborative approach to medical decisions, especially for preference-sensitive conditions like prostate cancer where treatment options have different side effect profiles with similar survival rates.

The concept of shared decision-making (SDM) originated in 1982 from the President's Commission for the Study of Ethical Problems in Medicine. While traditional SDM revolves around physician-driven information, today's model needs to evolve to accommodate patient-generated information as well—even when that information comes from sources doctors might consider dubious.

A three-step model proposed by Glyn Elwyn and colleagues in 2012 for incorporating shared decision-making begins with "choice talk," ensuring patients know about reasonable options. However, Dr. Millstein suggests that in today's digital media environment, it may be better to start from a more curious, open-ended place—inviting patients' thoughts and ideas from the outset. This approach conveys clinician humility and openness to unconventional information.

Benefits of Enhanced Shared Decision-Making

Recent research supports this enhanced approach to SDM:

• A study published in PubMed found that encouraging all prostate cancer patients to be actively involved in treatment decisions—regardless of their stated preferences for involvement—led to better outcomes. Patients with active involvement demonstrated more prostate cancer knowledge, less decision conflict, and less decision regret.
• Research published in ScienceDirect suggests that shared decision-making may be a trackable metric of quality healthcare. The study found that patients who experienced SDM and underwent PSA screening were also more likely to engage in other preventative health behaviors.
• According to the American Urological Association, the benefits of SDM "result from a relationship of trust and mutual respect between patient and care team." Patients who perceive they've participated in healthcare decisions often report feeling more informed and empowered.

Practical Tools for Enhanced Decision-Making

Several initiatives support this new paradigm:

• Researchers have developed automated decision aids for patient-centric treatment decision-making using decision analysis, preference thresholds, and value elicitations to maximize the compatibility between a patient's treatment expectations and outcomes.
• Dutch researchers have created a web-based patient decision aid including personalized risk information with visualization tools like icon arrays, numbers, and verbal explanations to communicate the risks of treatment side effects.
• The Oncology Nursing Society (ONS) offers resources including FAQs, background on shared decision-making importance, and conversation starters to help prompt open discussion.

Challenges Remain

Despite consensus among guidelines endorsing SDM practice, implementation varies widely:

• Studies show the prevalence of SDM occurring before prostate-specific antigen testing decisions varies between 11% and 98%, and was higher in studies where SDM was self-reported by physicians compared to patient-reported recollections.
• Research examining audio-recorded patient-provider interactions found limited SDM during PSA screening consultations among Black men. When counseling did take place, it utilized SDM components but inconsistently and incompletely.

The Way Forward

Dr. Millstein advocates for a new paradigm where shared decision-making begins with shared information. Physicians need to welcome and acknowledge all ideas brought to them and approach patients' digital research with curiosity rather than dismissal. He suggests that "patients want a new shared decision-making paradigm where all possibilities are out on the table, and doctors don't get a running start."

For prostate cancer patients, this means coming prepared to appointments with your research and questions, but also being open to the physician's expertise. For physicians, it means creating space for patients to share their findings and concerns before presenting medical recommendations.

Resources for Patients

• ONS Shared Decision Making in Prostate Cancer
• American Urological Association Shared Decision Making Resource
• Journal of Medical Internet Research on Physician-Patient Communication

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Sources:

1. Millstein, J. (2025, April 4). Opinion | How Doctors Can Adapt to the Digital Communication Revolution. MedPage Today. https://www.medpagetoday.com/opinion/second-opinions/how-doctors-can-adapt-to-the-digital-communication-revolution
2. Journal of Medical Internet Research - Mechanism Assessment of Physician Discourse Strategies and Patient Consultation Behaviors on Online Health Platforms: Mixed Methods Study. (2025). https://www.jmir.org/2025/1/e54516
3. Implementation of Shared Decision Making into Urological Practice - American Urological Association. (n.d.). https://www.auanet.org/guidelines-and-quality/quality-and-measurement/quality-improvement/clinical-consensus-statement-and-quality-improvement-issue-brief-(ccs-and-qiib)/shared-decision-making
4. Shared Decision Making in Prostate Cancer Care-Encouraging Every Patient to be Actively Involved in Decision Making or Ensuring the Patient Preferred Level of Involvement? - PubMed. (n.d.). https://pubmed.ncbi.nlm.nih.gov/29501555/
5. Shared decision-making before prostate cancer screening decisions | Nature Reviews Urology. (n.d.). https://www.nature.com/articles/s41585-023-00840-0
6. "Shared decision-making" for prostate cancer screening: Is it a marker of quality preventative healthcare? - ScienceDirect. (n.d.). https://www.sciencedirect.com/science/article/abs/pii/S1877782123001728
7. Limited Evidence of Shared Decision Making for Prostate Cancer Screening in Audio-Recorded Primary Care Visits Among Black Men and their Healthcare Providers | Journal of Immigrant and Minority Health. (n.d.). https://link.springer.com/article/10.1007/s10903-024-01606-5
8. Taking shared decision making for prostate cancer to the next level: Requirements for a Dutch treatment decision aid with personalized risks on side effects - ScienceDirect. (n.d.). https://www.sciencedirect.com/science/article/pii/S2214782923000064
9. A personalized decision aid for prostate cancer shared decision making | BMC Medical Informatics and Decision Making. (n.d.). https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-021-01732-2
10. Shared Decision Making in Prostate Cancer | ONS. (n.d.). https://www.ons.org/clinical-practice-resources/shared-decision-making-prostate-cancer
11. Care Cues: Shared Decision-Making in Prostate Cancer. (2024, May 9). Medscape. https://www.medscape.com/viewarticle/972944

How Doctors Can Adapt to the Digital Communication Revolution | MedPage Today

medpagetoday.com

by Jeffrey Millstein, MD

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Perspectives > Second Opinions

— It's time for a new shared decision-making paradigm

April 4, 2025

Millstein is an attending physician.

A 60-year-old patient of mine was recently diagnosed with prostate cancer. He described the treatment options that were discussed with him -- surgery or radiation -- and then told me the surgeon said, "If you were my father, I would tell you to have surgery," and listed his reasons.

There were a few alternatives my patient found on the internet and wanted to bring up, but he felt that, while well-meaning, the surgeon's son-to-father advice essentially shut him down. He shared his ideas with me, and we worked on a plan to help him get them into the treatment conversation with the specialist. None of my patient's ideas were evidence-based, but he found them compelling nonetheless.

Not long ago, "Dr. Google" was something that provoked an exasperated head shake or eye roll from doctors, and apologies from patients who let it slip that they had researched their symptoms online. Unfiltered information was plentiful, but doctors could, in most cases, brush it aside, count on our status as experts, and quite easily pull rank on internet doctoring. Not anymore. With the proliferation of digital wearables, artificial intelligence chatbots, and symptom checkers, along with greater healthcare data transparency, patients have ever more powerful tools at their disposal that may compete with doctors' recommendations.

Alongside these devices and information, patients today are generally more emboldened to question the opinions of experts. This may be, at least in part, due to our current political environment where non-factual narratives have equal or greater airplay and support at ever higher levels of national leadership. The way expertise has traditionally been espoused is now met with increasing skepticism or disdain.

Like it or not, this is the world we live in, and fact-checking, head-on debate, or claiming the moral high ground are often ineffective at swaying opinions and influencing decisions. Major structural health system reform still seems a long way off.

So, what are doctors and other well-meaning healthcare providers to do? Some insist on squaring off, have chosen to leave the profession altogether, or just trudge along, accumulating anger, despair, and succumbing to moral injury. While these outcomes are understandable in current circumstances, a ray of hopeful optimism may lie in re-examining the way patients and doctors engage in shared decision-making.

Medical News from Around the Web

Shared decision-making -- a term that was first used in a 1982 reportopens in a new tab or window from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research -- was born out of our modern ethics of patient self-determination, but most often revolves around physician-driven information. The medical facts are presented, options outlined, risks and benefits based on available scientific studies are discussed, and doctors help patients make informed decisions that conform to their personal values and priorities.

Today, patients are increasingly likely to bring self-generated information to the discussion, some of which may come from dubious sources. Social media algorithms that drive engagement around topics with a visceral appeal certainly play a role. There may even be a physiologic influence, as neuroimaging studies have suggestedopens in a new tab or window brain structure correlates to some beliefs despite evidence to the contrary. The way doctors respond to this misinformation is key -- it can either further erode trust or possibly help fortify it and pave a constructive path forward.

In 2012, Glyn Elwyn, PhD, et al. proposed a three-step modelopens in a new tab or window for incorporating shared decision-making into clinical practice. The first step in this model is "choice talk," making sure patients know about reasonable choices. In this step, choices are offered, while respect for personal preference and honest discussion of medical uncertainty are emphasized.

In today's digital media infused era, it may be best to start from a more curious, open-ended place and invite patients' thoughts and ideas from the outset. Assessing what patients already know and how they came to know this information can be very affirming, and evidence suggestsopens in a new tab or window that patients may appreciate an invitation to express their opinion even if they do not ask to. This approach also conveys a clinician's humility, openness to receiving unconventional information, and acceptance of a more collaborative power dynamic.

In the second and third steps, "option talk" and "decision talk," doctors and patients can dive deeper into knowledge checks, risks, benefits, decision support resources, and matching an option to personal values and preferences. At this point, rather than imposing external pressure, it may be more effective to pull from the coaching and motivational interviewing playbookopens in a new tab or window, exploring self-reflection and patients' own intrinsic motivation, and allowing them to take greater ownership of their decisions. The timeline for this, of course, must be adapted to the level of urgency the clinical situation requires.

As I saw with my patient, focusing too quickly on medical expert-centered options can drive away growing numbers of people who are entrenched in their own digital media odyssey. Even kind, personal advice, like how a doctor might treat a close relative, can come across as dismissive.

Today, shared decision-making needs to begin with shared information. Doctors need to at least welcome and acknowledge all ideas brought to them and apply a curiosity lens to try and see why it resonates. Patients want a new shared decision-making paradigm where all possibilities are out on the table, and doctors don't get a running start.

Jeffrey Millstein, MD,opens in a new tab or window is an attending physician at Penn Medicine Woodbury Heights in New Jersey, and a clinical assistant professor of medicine at the Perelman School of Medicine in Philadelphia.