Designing Normative Messages About Active Surveillance for Men With Localized Prostate Cancer

Abstract

Active surveillance (AS) is increasingly recognized as a reasonable option for men with low-risk, localized prostate cancer, yet few men who might benefit from conservative management receive it. We examined the acceptability of normative messages about AS as a management option for patients with low-risk prostate cancer. Men with a diagnosis of localized prostate cancer who were recruited through prostate cancer support organizations completed a web-based survey (N=331). They rated messages about AS for believability, accuracy, and importance for men to hear when making treatment decisions. The message “you don’t have to panic…you have time to think about your options” was perceived as believable, accurate, and important by over 80% of the survivors. In contrast, messages about trust in the AS protocol and “knowing in plenty of time” if treatment is needed were rated as accurate by only about 36% of respondents. For AS to be viewed as a reasonable alternative, men will need reassurance that following an AS protocol is likely to allow time for curative treatment if the cancer progresses.

Patient and provider experiences with active surveillance: A scoping review

“…[ 66 ] Those who felt they had not received sufficient information reported high rates of stress [ 96 ]. A study of normative messaging found that men needed reassurance that AS is likely to allow time for curative treatment if the cancer progresses [ 48 ]. In two studies, men wished to be discrete about their condition, did not discuss concerns with their spouse and/or other support group structures, and used the Internet as a primary source of information about prostate cancer [ 45 , 74 ].…”

Editorial Comment

“…How we frame the concept of risk in our interactions with patients and how we convey our own comfort with surveillance improves patient acceptance and adherence to active surveillance. 1,2 There is an opportunity here to study how we quantify and communicate risk and how it is perceived and interpreted by patients.…”

Toward ethically responsible choice architecture in prostate cancer treatment decision‐making

“…For example, one study of 331 survivors of prostate cancer found that a normative message of “You don't have to panic…you have time to think about your options” was perceived as believable, accurate, and important to hear by over 80% of men, and 60.4% believed that this message would make men more likely to choose active surveillance. The message rated the highest in terms of likelihood to impact choice was “As long as I'm keeping a close eye on it with my doctors, I can possibly prolong this for a number of years until the treatment options have improved,” and 77.3% believed that hearing this message would make a man more likely to choose active surveillance . Moreover, because physician recommendations create powerful social norms, physicians should avoid recommending surgery or radiation as the only reasonable choices for patients with low‐risk, localized prostate cancer.…”