The Self-Management of Uncertainty Among Men Undertaking Active Surveillance for Low-Risk Prostate Cancer

Abstract

Asymptomatic men with low-risk, early-stage prostate cancer are eligible for active surveillance (AS), which offers a means to monitor the cancer while delaying treatment. However, AS operates within a unique set of circumstances that advocate monitoring, rather than immediate treatment, and men's health practices are central to coping with the inherent uncertainty of living with an untreated cancer. A qualitative study was completed to describe the range of men's self-management strategies used to overcome AS-related uncertainty. The study findings reveal two strategies. First, positioning prostate cancer as benign through stoicism and solitary discourses were common to men intent on "living a normal life." Second, men committed to "doing something extra" complemented AS protocols, and often collaborated with their wives to focus on diet as an adjunct therapy. Although most participants exhibited typical men's health practices, it is clear that tailored AS psychosocial interventions will benefit men and their families.

‘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

“…When combined with values-clarification exercises, this information could possibly assist men's capacity for decision-making based on personal needs and may reduce pressure from misinformed family and friends. As found elsewhere, occasional partners were distressed by men's AS decisions and monitoring [24]. Hence, partners would also likely benefit from enhanced recognition within LPC information sources, treatment support, medical consultations, and decision aids emerging in this field [33,34].…”

Identifying the self-management behaviours performed by prostate cancer survivors: a systematic review of the evidence

“…One qualitative study sampled men undergoing the active surveillance programme for localised prostate cancer (Oliffe et al, 2009), and the other qualitative study sampled men Budget constraints and the costs involved for translation. This is the primary context of the review and therefore, other cancer sites were excluded.…”

“…Prostate cancer is managed as a chronic illness requiring long-term surveillance (Hoffman et al, 2006;Oliffe et al, 2009), and in some cases long-term treatment (Fransson, 2008;Ott and Fulton, 2005). Worldwide enablement of self-management for cancer survivors is increasingly being recognised as a fundamental component of effective management of cancer care as a long-term condition (Department of Health Macmillan Cancer Support & NHS Improvement, 2010;Fenlon and Foster, 2009;McCorkle et al, 2011;Wilson, 2008).…”

“…Consequently, there is now a growing interest in the development of supported self-management interventions for men affected by prostate cancer (Cockle-Hearne and Faithfull, 2010;Department of Health Macmillan Cancer Support & NHS Improvement, 2010;Faithfull et al, 2011). Identifying the self-management behaviours used by prostate cancer survivors is a very important step towards the development of supported self-management interventions (Cockle-Hearne and Faithfull, 2010;Oliffe et al, 2009). The assessment of self-management behaviours may facilitate an understanding of the barriers encountered while self-managing, and provide useful insights into how men can be better supported to self-manage (Cockle-Hearne and Faithfull, 2010;Davies and Batehup, 2010).…”

Choosing Health, Choosing Treatment: Patient Choice After Diagnosis of Localized Prostate Cancer

“…Patients place a high priority on the day-to-day practicalities of living with cancer (22) and this would seem to include the practical process of making decisions about treatment for localised prostate cancer. There is good reason for distinguishing between 'choosingtreatment' and 'treatment' periods in the prostate cancer journey because, for example, there is evidence that once a treatment decision has been made information gathering ends (2) and new behaviours are taken up in addition to treatment, such as improvements in diet (23). Service changes at YCC could help to ensure that all patients are better informed but because choosing treatment is so complicated it is important to follow up such service changes with an exploration of patients and carers lived experience of them.…”