**5.4.1 Clinical vignettes**

66 Prostate Cancer – Diagnostic and Therapeutic Advances

outcomes of the procedures, they leave behind the process by which the outcomes are achieved. In contrast, men not only focus on the outcomes of care, but more important to them, the process of care (Jayadevappa et al., 2010). The way that health professionals deliver prostate cancer care can significantly influence men's active engagement in their care (Martinez et al., 2009). Knowledge of disease progression and response to treatments is key for men living with advanced or recurrent prostate cancer, because they need instrumental knowledge to deal with uncertainty about how long their bodies will be able to respond to

Being a partner in care means being a decision maker. Stacey et al. (2010) report that men want more opportunity to decide than they are allowed. Their vehemence remains unchanged if they are not offered decision aids or the opportunity to discuss the details of treatment with health professionals. This vehemence applies equally to the informed consent process, which usually requires more in-depth information and clearer explanations to support men's understanding. Moreover, men want more information on potential harms of therapies, since health professionals tend to present more often the benefits. As discussed in Section 5.2, men's partners should be considered in the process of decision-making. To include men's partners, Illingworth et al. (2010) propose that health professionals talk to men about their significant others and all spheres of their lives. These authors emphasize the central role of men's interpersonal relationships in

Finally, the last challenge for professionals relates to collaboration within their own professions and with other health and social professions. It is known that limited professional links between family physicians and urologists erect structural barriers for health care delivery to older men (Greene & Adelman, 2003). It is beyond the scope of this section to suggest that other members of multidisciplinary cancer-care teams change their practice, due to ethical principles. However, we would like to highlight that Zanchetta (2004), at the time an oncology nurse interested in health literacy, made some recommendations to nurses to counteract misconceptions about older men's health literacy. These recommendations may inspire other professionals. Aiming to awake and enhance nurses' awareness of their opportunity, and responsibility, to expand professional knowledge about men's health literacy, Zanchetta (2004) recommended that nurses (a) be aware that functional health literacy is a result of a broad, socially constructed process, rather than a set of abilities comprising reading, counting, and recognition of words, (b) be particularly attentive to the nature and extension of individual men's social networks, (c) encourage men to collaborate with nurses in creating educational materials, (d) invite physicians to co-create educational materials that respond to knowledge gaps and misunderstandings about prostate cancer, (e) redesign, with men, innovative strategies to communicate others' experiences with cancer, and (f) record their clinical observations of

Enhancing the quality of prostate cancer care involves more than advances in science and technology. It requires engaging patients in treatment-related decisions and fostering a health care environment that facilitates health literacy among patients. The patient-centered care approach enables health care professionals to focus on patients as well as their significant others, as they journey through the prostate cancer trajectory. Engaging patients through patient-centered care allows their collaboration with health care professionals to

therapies (Nanton et al., 2009).

their experiences with prostate cancer.

the differences among men's information behaviors.

fulfil the goal of *caring with the patient*.

