Patient treatment preferences in localized prostate carcinoma: The influence of emotion, misconception, and anecdote

Abstract

BACKGROUND. Multiple therapeutic options exist for localized prostate carcinoma, without conclusive evidence to guide the choice of treatment. Thus, treatment should reflect trade‐offs between the probability of curing disease and the desire to avoid treatment‐associated side effects. Factors that actually influence patient treatment preferences are poorly understood. METHODS. We reviewed medical records and carried out in‐depth, semistructured interviews of 20 men with newly‐diagnosed, clinically‐localized prostate carcinoma in a Veterans Affairs Hospital following their first consultations with urologists and before treatments were initiated. Six to eight months after treatment, we carried out follow‐up interviews. Interviews explored beliefs and attitudes about prostate cancer and treatment options, emotional reactions to the diagnosis, treatment preferences, information sources, and perceptions of interactions with urologists. RESULTS. Patient treatment preferences were not based on careful assessments of numerical risks for various clinical outcomes. Instead, feelings of fear and uncertainty contributed to a desire for rapid treatment, and specific preferences were profoundly influenced by misconceptions, especially about prostatectomy, and by anecdotes about the experiences of others with cancer. Few patients wanted to seek second opinions. Most patients received treatments that matched their initial preferences. Afterwards, they justified their choices in terms of the same misconceptions and anecdotal influences invoked during treatment deliberation. CONCLUSIONS. For men with localized prostate carcinoma, the treatment decision‐making process would benefit from interventions that moderate feelings of fear and a desire for rapid treatment, dispel common and powerful misconceptions about prostate cancer and its therapies, and help patients avoid over‐reliance on anecdotes. Cancer 2006. © 2006 American Cancer Society.

Psychological and Social Factors influencing Patients’ Treatment Selection for Localised Prostate Cancer

“…Patients' beliefs and other influences in selecting to undergo a radical prostatectomy were clearly reported in nine of the studies [27][28][29][30][31][32][33][34][35]. Many of the patients perceived their cancer as a localised problem and that the most tangible and definitive method of curing or preventing the disease from spreading was to remove the tumour [27-29, 31, 35].…”

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

“…1,5,25 And Mr. Thompson does not seem to grasp accurately the relative impact of anxiety versus surgical side effects on his future quality of life. 8,26 Their clinicians view these patients' decisions as tragic but believe they have nothing else to offer, having informed these patients about the medical facts. To further question them seems like meddling with personal values.…”

“…For example, Mr. Thompson's physician could have let him know that research shows that anxiety lessens for most people over time, but that incontinence often causes an ongoing depreciation in quality of life. 8,26 Recent research suggests that it is possible to help people better envision adaptation. 30 Support groups for cancer survivors have been shown to engender optimism and active coping.…”

Patient Decision Aids for Prostate Cancer Treatment: A Systematic Review of the Literature

“…[8][9][10] Because of a poor understanding of the disease and treatment options, fear and misconceptions dominate the decision-making process, [11][12][13] and patients often defer treatment decisions to their physician. 9,14 However, evidence suggests that physicians and patients have different goals for prostate cancer care 15 and physicians' perceptions of the preferences of their own patients are not accurate. [16][17][18] The strongest predictor of treatment choice is not patient preference but physician specialty; specialists overwhelmingly recommend the treatment they deliver.…”