Treatment decision‐making strategies and influences in patients with localized prostate carcinoma

• Published in: Cancer 2005-10, Vol.104 (7), p.1381-1390
• Main Authors: Gwede, Clement K., Pow‐Sang, Julio, Seigne, John, Heysek, Randy, Helal, Mohamed, Shade, Kristin, Cantor, Alan, Jacobsen, Paul B.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Attitude to Health; Biological and medical sciences; Brachytherapy - methods; Brachytherapy - statistics & numerical data; Decision Making; Follow-Up Studies; Humans; informed decision making; Male; medical decision making; Medical sciences; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness - pathology; Neoplasm Staging; Nephrology. Urinary tract diseases; Patient Satisfaction; Probability; Prospective Studies; prostate carcinoma; Prostatectomy - methods; Prostatectomy - statistics & numerical data; Prostatic Neoplasms - pathology; Prostatic Neoplasms - psychology; Prostatic Neoplasms - therapy; Risk Assessment; shared decision making; Stress, Psychological; treatment decision making; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21330

BACKGROUND Patients diagnosed with localized prostate carcinoma need to interpret complicated medical information to make an informed treatment selection from among treatments that have comparable efficacy but differing side effects. The authors reported initial results for treatment decision‐making strategies among men receiving definitive treatment for localized prostate carcinoma. METHODS One hundred nineteen men treated with radical prostatectomy (44%) or brachytherapy (56%) consented to participate. Guided by a cognitive‐affective theoretic framework, the authors assessed differences in decision‐making strategies, and treatment and disease‐relevant beliefs and affects, in addition to demographic and clinical variables. RESULTS Approximately half of patients reported difficulty (49%) and distress (45%) while making treatment decisions, but no regrets (74%) regarding the treatment choice they made. Patients who underwent prostatectomy were younger, were more likely to be employed, had worse tumor grade, and had a shorter time since diagnosis (P < 0.01) compared with patients who did not undergo prostatectomy. In multivariate analyses, compared with patients who received radical prostatectomy, patients who received brachytherapy were more likely to say that they chose this treatment because it was “the least invasive” and they “wanted to avoid surgery” (P < 0.0001). CONCLUSIONS In general, patients who received brachytherapy chose this treatment because of quality of life considerations, whereas “cure” and complete removal of the tumor were the main motivations for patients selecting radical prostatectomy. Long‐term data are needed to evaluate distress and decisional regret as patients experience treatment‐related chronic side effects and efficacy outcomes. Decision‐making aids or other interventions to reduce decisional difficulty and emotional distress during decision making were indicated. Cancer 2005. © 2005 American Cancer Society. In general, patients chose brachytherapy because of quality of life considerations and because they believed more strongly that this treatment was the least invasive, and they wanted to avoid surgery. In contrast, “cure” and complete removal of the tumor were the main motivations for patients selecting radical prostatectomy. Approximately half of the patients reported difficulty (49%) and distress (45%) while making treatment decision, but no regrets (74%) regarding the treatment choice they made. Long‐term data are neede