Patients diagnosed with low-risk prostate cancer (PCa) are confronted with a difficult decision regarding whether to undergo definitive treatment or to pursue an active surveillance protocol. This is potentially further complicated by the possibility that patients and physicians may place different value on factors that influence this decision. We conducted a qualitative investigation to better understand patient and physician perceptions of factors influencing treatment decisions for low-risk PCa.
Semi-structured interviews were conducted among 43 racially and ethnically diverse patients diagnosed with low-risk PCa, who were identified through a population-based cancer registry, and 15 physicians who were selected to represent a variety of practice settings in the Greater San Francisco Bay Area.
Patients and physicians both described several key individual (e.g., clinical) and interpersonal (e.g., healthcare communications) factors as important for treatment decision-making. Overall, physicians' perceptions largely mirrored patients' perceptions. First, we observed differences in treatment preferences by age and stage of life. At older ages, there was a preference for less invasive options. However, at younger ages, we found varying opinions among both patients and physicians. Second, patients and physicians both described concerns about side effects including physical functioning and non-physical considerations. Third, we observed differences in expectations and the level of difficulty for clinical conversations based on information needs and resources between patients and physicians. Finally, we discovered that patients and physicians perceived patients' prior knowledge and the support of family/friends as facilitators of clinical conversations.
Our study suggests that the gap between patient and physician perceptions on the influence of clinical and communication factors on treatment decision-making is not large. The consensus we observed points to the importance of developing relevant clinical communication roadmaps as well as high quality and accessible patient education materials.
BMC cancer. 2023 Dec 05*** epublish ***
Alice Guan, Eduardo J Santiago-Rodríguez, Benjamin I Chung, Janet K Shim, Laura Allen, Mei-Chin Kuo, Kathie Lau, Zinnia Loya, James D Brooks, Iona Cheng, Mindy C DeRouen, Dominick L Frosch, Todd Golden, John T Leppert, Daphne Y Lichtensztajn, Qian Lu, Debora Oh, Weiva Sieh, Michelle Wadhwa, Matthew R Cooperberg, Peter R Carroll, Scarlett L Gomez, Salma Shariff-Marco
Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States., Department of Urology, Stanford University, Palo Alto, United States., UCSF | Department of Social & Behavioral Sciences, San Francisco, United States., Health Science Diligence Advisors, LLC, San Francisco, United States., Dept of Health Disparities Research, University of Texas MD-Anderson Cancer Center, Houston, United States., Dept of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, United States., UCSF | Department of Urology, San Francisco, United States., Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States. .