Table 5.

Potential validity challenges

Context fit with localized prostate cancer decision
Nature of disease:
Maybe if I had a different kind of cancer I would choose D or E.
Maybe D or E [passive role] would be acceptable if there was an imminent threat or immediate need to make a decision, but that’s not my situation.
E would only happen “if you really didn’t have choices.”
Multiple doctors:
I try to interpret words as they are written, and the question here is which doctor?
[Specialists are] like housepainters, each one wants you to do business with them--you can brush paint your house or spray paint your house.
Pressure to assume “active” role (response A or B)
C [shared role] is not relevant because the docs didn’t try to share the decision with me.
It would be a perfect world if D were possible, but D and E [passive role] would never occur.
I would have had to go out of my way to find a doctor who would make the decision for me.
“My surgeons were adamant that I make the final decision.”
Unclear who does what in “shared” role (response C)
C is the same as B.
[C] is just in the middle of [A and E] but I wouldn’t pick it. Someone has to make the final decision or you’re just hanging out in limbo.
I can’t see how you could share responsibility. Either I give him authority or I don’t. What would that look like? The doctor can’t take half the responsibility if the treatment goes wrong. [C] is not a realistic scenario.
Where does the responsibility lie if it’s the wrong decision?
Either I give him authority or I don’t.