Patient‐focussed decision‐making in early‐stage prostate cancer: insights from a cognitively based decision aid

Abstract

Purpose To study the cognitive processes of early-stage prostate cancer patients as they determined which treatment they preferred, using our cognitively based decision aid.Method The aid was a one-to-one interview that included the structured presentation of information, listing exercises in which the patient identified attributes important to his decision, and trade-off exercises to help him weigh and integrate those attributes together. At various points of the interview, patients identified the attributes they felt were important to their decision, rated their treatment options and completed standardized assessments relating to their decision. In addition, patients participated in a follow-up interview at the time they made their actual treatment decision and again 3 months later.Results Sixty of 70 (86%) of the invited patients participated in the study. Participating patients identified a median of four important attributes (range 1-10); 36 different attributes were identified at some point in the interview by the group. During the interview, 78% of patients changed which attributes they considered important, and 72% changed their treatment ratings. Stability of treatment choice after the interview and lack of regret after the decision were each positively associated with increasing differentiation between treatment options over time. ConclusionsThe decision process appears to be dynamic for the patients with great variability across patients in what is important to the decision. Increasing stability of choice and lack of regret appear to be related positively to increasing difference over time in how attractive the preferred option is over its closest competitor, rather than to the size of the difference at any one point in time.

‘What is this active surveillance thing?’ Men's and partners' reactions to treatment decision making for prostate cancer when active surveillance is the recommended treatment option

“…It is also possible that men rapidly differentiate and consolidate options to manage decisions, as espoused by decision-making theory [34,36]. The findings also indicate that some men defer treatment decisions to their doctors [16,22].…”

Why do men choose one treatment over another?

“…When patients were asked to rank all the factors that were important to their decision, urinary function and bowel function were the only 2 factors found to be important to greater than 50% of patients. 26 This study also found that fewer than 20% of men reported sexual functioning as 1 of the top 3 attributes important to their decision, although 32% mentioned that it was important. A different study found that 49% of men were concerned about incontinence and 38% were concerned about impotence.…”

“…For example, in 1 study of 60 patients, 18 different attributes of treatment were identified as being the "most important." 26 …”

“…23 In a different study, the effect of treatment on ability to work was ranked as the first or second most important factor by 4% of patients. 26 One study observed that brachytherapy was popular among working patients and their partners. 45 In another study, men who did not choose radiation indicated that they perceived radiation therapy to be time-consuming and disruptive to their daily schedule.…”

“…In another study, fewer than 20% of patients ranked either "effect of treatment on length of life" or "chances of dying of cancer" as 1 of the 4 most important factors in making a decision. 26 In 1 study of health state preferences, 2 of 5 men were unconditionally willing to risk side effects for any potential gain in life expectancy. 64 These studies suggest that there is substantial variation in the significance that patients place on cancer eradication, and that treatment efficacy means more than "control" of the tumor for many patients.…”