Describing perspectives of health care professionals on active surveillance for the management of prostate cancer

Abstract

BackgroundOver the last decade, active surveillance has proven to be a safe approach for patients with low-risk prostate cancer. Although active surveillance presents several advantages for both patients and the health care system, all eligible patients do not adopt this approach. Our goal was to evaluate the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach.MethodsFocus groups (n = 5) were held with physicians who provided care for men with low-risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of health care professionals (HCPs) was captured to understand their decisions in proposing active surveillance and to reveal the barriers and facilitators that affect the adherence to this approach. A content analysis was performed on the verbatim transcripts from the sessions.ResultsAlthough physicians agreed that active surveillance is a suitable approach for low-risk prostate cancer patients, they were concerned about the rapidly evolving and non-standardized guidelines for patient follow-up. They pointed out the need for additional tools to appropriately identify proper patients for whom active surveillance is the best option. Urologists and radiation-oncologists were keen to collaborate with each other, but the role of general practitioner remained controversial once patients were referred to a specialist.ConclusionsIntegration of more reliable tools and/or markers in addition to more specific guidelines for patient follow-up would increase the confidence of both patients and physicians in the choice of active surveillance.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3273-9) contains supplementary material, which is available to authorized users.

Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: A Qualitative Analysis of Community and Academic Urologists

“…Our nding that physicians perceive rapidly evolving and non-standardized follow-up protocols as a barrier to the adoption of AS has also been reported previously [54]. Research is underway to clarify biopsy and surveillance protocols, which may reduce uncertainty in selecting and following patients on AS [5,[55][56][57], particularly for young men [55].…”

Comparing Perspectives of Canadian Men Diagnosed With Prostate Cancer and Health Care Professionals About Active Surveillance

“…Description of the data collection has been presented in detail previously ( 14 , 15 ). Briefly, focus groups were held in 2013 throughout 2015 in Montreal, Toronto, Thunder Bay, Winnipeg, and Vancouver.…”

“…With 1 exception (Thunder Bay), all focus groups were held in metropolitan academic centers that served as regional referral sites where prostate cancer care was delivered within specialized clinical programs. Focus groups included men (7 groups, N = 52) who had been diagnosed with prostate cancer and were eligible for AS ( 14 ), and physicians (5 groups, N = 48) who managed low- and high-risk prostate cancer patients and engaged in conversations regarding AS ( 15 ). Eligible individuals were purposefully invited to participate by a research coordinator working in the local care center and formed a convenience sample.…”

“…Eligible individuals were purposefully invited to participate by a research coordinator working in the local care center and formed a convenience sample. Research ethics approval was obtained from ethics boards at each site, and participants signed an informed consent ( 14 , 15 ).…”

“…Previously, we undertook a qualitative investigation to deepen our knowledge about perspectives that influence men in their decision-making about AS and the nature of current practices for informing them about this course of action ( 14 , 15 ). We held focus groups in 4 Canadian provinces with men and doctors and gathered a rich understanding of participants’ perspectives about AS.…”