Scott Department of Urology, Baylor College of Medicine, 6620 Main Street Houston, TX.VA Health Services Research & Development Center of Excellence, Michael E. DeBakey VA Medical Center Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Duke University School of Nursing, Durham, NC; Fairfield University, Fairfield, CT; San Francisco VA Medical Center, Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA.
Study Type - Therapy (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? Men with prostate cancer who choose active surveillance may experience anxiety and depression. Higher anxiety related to uncertainty surrounding cancer has been shown to increase the likelihood of choosing active treatment in the absence of a clinical indication. Certain characteristics, including physician influence and a neurotic personality, may also increase the risk of psychological distress. Our study identified particular areas that may affect the degree of satisfaction or uncertainty experienced by men choosing active surveillance. We showed that men with a positive outlook who perceived that they were receiving consistent medical information had improved ability to manage uncertainty and felt more in control of their decision-making. Men who were confident in their ability to manage prostate-related symptoms also had less insecurity with their decision.
To understand the factors associated with decision-making, we conducted a telephone-based survey as part of a pilot study to develop a psychoeducational intervention for men with prostate cancer who undergo active surveillance.
From 2007 to 2008, we conducted a cross-sectional study of 34 individuals on active surveillance for prostate cancer. We examined how specific mental health, quality of life and sociodemographic characteristics relate to decision-making. Five validated decision-making scales were used as primary outcomes reflecting the amount of satisfaction, regret and conflict a participant experienced about his decision to undergo active surveillance. A multivariate regression model was developed to identify specific psychosocial factors related to the decision-making outcomes.
Primary analyses focused on the decisional satisfaction and conflict measures, as the decisional regret measure showed poor reliability (α < 0.70) in this sample. Four psychosocial measures showed strong associations across the decision-making subscales, including the Fife Constructed Meaning Scale (Pearson r > 0.26), Mishel Uncertainty in Illness Scale - Inconsistency (r > 0.32), Mental Health Index-5 (r > 0.33), and Lepore self-efficacy for prostate symptom management scale (r > 0.33). Individuals with higher self-efficacy for prostate cancer symptom management (P= 0.02) and higher positive meaning for cancer (P= 0.03) were less likely to express decision-making conflict as the result of uncertainty. Individuals reporting higher positive meaning for cancer (P= 0.01) and less uncertainty in illness attributed to inconsistency (P= 0.02) were less likely to exhibit decision-making conflict related to the perceived effectiveness of treatment.
Men choosing active surveillance represent a patient group with unique vulnerabilities that require new psychoeducational interventions to provide information and support that will maintain and improve quality of life. We describe specific characteristics that may put patients at higher risk during the decision-making process and indicate their increased need for such interventions.
Goh AC, Kowalkowski MA, Bailey Jr DE, Kazer MW, Knight SJ, Latini DM. Are you the author?
Reference: BJU Int. 2011 Dec 7. Epub ahead of print.