Making decisions about treatment for localized prostate cancer

Abstract

Objective To describe the decision-making processes used by men diagnosed with localized prostate cancer who were considering treatment. Patients and methods Men newly diagnosed with localized prostate cancer from outpatient urology clinics and urologists' private practices were approached before treatment. Their decision-making processes and information-seeking behaviour was assessed; demographic information was also obtained. Results Of 119 men approached, 108 (90%) were interviewed; 91% reported non-systematic decision processes, with deferral to the doctor, positive and negative recollections of others' cancer experiences, and the pre-existing belief that surgery is a better cancer treatment being most common. For systematic information processing the mean (SD, range) number of items considered was 4.19 (2.28, 0±11), with 57% of men considering four or fewer treatment/medical aspects of prostate cancer. Men most commonly considered cancer stage (59%), urinary incontinence (55%) and impotence (51%) after surgery, and low overall mortality (45%). Uncertainty about probabilities for cure was reported by 43% of men and fear of cancer spread by 37%. Men also described uncertainty about the probabilities of side-effects (27%), decisional uncertainty (25%) and anticipated decisional regret (18%). Overall, 73% of men sought information about prostate cancer from external sources, most commonly the Internet, followed by family and friends. Conclusions In general, men did not use information about medical treatments comprehensively or systematically when making treatment decisions, and their processing of medical information was biased by their previous beliefs about cancer and health. These ®ndings have implications for the provision of informational and decisional support to men considering prostate cancer treatment.

Anxiety and depression after prostate cancer diagnosis and treatment: 5-year follow-up

“…A second explanation could be that surgery led to more reassurance since -contrary to radiotherapy -the prostate actually is removed. Previous research has suggested that men may choose surgery on the basis of the lay belief that surgical removal is the most effective way to cure cancer (Steginga et al, 2002). A third explanation could be age, since high-anxiety radiotherapy men were significantly older than high-anxiety prostatectomy men.…”

Psychological aspects of prostate cancer: a clinical review

“…70 Many men entertain multiple second opinions regarding their primary therapy, although this for some men adds to more confusion and distress because of the lack of agreement among practitioners. 71 They often take in information from reasonable and reliable sources and any number of unverified sources on the internet. This amount of information can lead to significant anxiety while trying to make a reasonable treatment decision.…”

Treatment decision making in prostate cancer: Patients’ participation in complex decisions

“…Medical decision making for PC is difficult. Sometimes for professionals, often for patients [12,26]. It is important to keep in mind that the individual patient may or may not feel comfortable with the responsibility of choosing between the available treatment options and too much encouragement towards active involvement in TDM may lead to unwanted control [27].…”