Factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: findings from a UK-wide mixed methods study


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Richard Wagland1,Eila Watson2
1University of Southampton,2Oxford Brookes University

Abstract

Background

Background: Men diagnosed with localised and locally advanced prostate cancer (PCa) are frequently offered a range of possible treatment options, including surgery, radiotherapy, brachytherapy, hormone therapy or combinations. Potential side effects, including sexual, urinary and bowel dysfunction, hot flushes, and weight gain, can vary by treatment type. Men also have the option of going on active surveillance or watchful waiting which avoids/delays active treatment. This study, part of a UK-wide, patient-reported outcome study entitled Life After Prostate Cancer Diagnosis, explored the treatment decision-making (TDM) experience of men diagnosed with Stage 1-111 PCa.

Method

Methods: Mixed-methods study incorporating a cross-sectional postal survey of men 18-42 months post-diagnosis and semi-structured interviews with a subsample (n=97, Stage 1-111). Interview data were analysed using Framework approach.

Results

Findings: Within the context of TDM, ‘drivers’ included men’s preferences about their level of involvement in decision-making or whether to delegate responsibility to clinicians, the relative intrusiveness of treatment or their desire for surgical excision (‘cut it out’), and work, personal and social life priorities. TDM ‘facilitators’ were mechanisms such as shared decision-making, communication and information sharing between patients, spouses and clinicians, that help clinicians enact, but also sometimes to challenge drivers. Drivers and facilitators can conflict, challenging patient empowerment. Men frequently undertook greater TDM responsibility than they desired, with no clinical recommendations to guide decisions; others reported receiving conflicting clinical recommendations from different clinicians involved in their care. Information on potential side effects was often reported as inadequate. Unchallenged preferences, absence of clinical recommendations and inadequate preparation for side effects sometimes led to decision regret.

Conclusion

Conclusions: TDM should involve men exercising preferences and priorities in discussion with clinicians. Men are not empowered when required to take more TDM responsibility than desired or when their potentially inappropriate preferences are unchallenged. Clinicians should ensure patients do not receive conflicting recommendations.