A Qualitative Study on Decision-Making by Prostate Cancer Physicians during Active Surveillance

To explore and identify factors that influence physicians' decisions while monitoring prostate cancer patients on active surveillance.

A purposive sampling strategy was used to identify physicians treating prostate cancer from diverse clinical backgrounds and geographic areas across the US. We conducted 24 in-depth interviews from July-December 2015, until thematic saturation was reached. The Applied Thematic Analysis framework was used to guide data collection and analysis. Interview transcripts were reviewed and coded independently by two researchers. Matrix analysis and NVivo software was used for organization and further analysis.

Eight key themes emerged to explain variation in active surveillance monitoring: 1) physician comfort with active surveillance, 2) protocol selection, 3) beliefs about the utility and quality of testing, 4) years of experience and exposure to AS during training, 5) concerns about inflicting "harm", 6) patient characteristics, 7) patient preferences, and 8) financial incentives.

These qualitative data reveal which factors influence physicians that manage patients on AS. There is tension between providing standardized care while also considering individual patients' needs and health status. Additional education on active surveillance is needed during urology training and continuing medical education. Future research is needed to empirically understand whether any specific protocol is superior to tailored, individualized care. This article is protected by copyright. All rights reserved.

BJU international. 2016 Sep 09 [Epub ahead of print]

Stacy Loeb, Caitlin Curnyn, Angela Fagerlin, R Scott Braithwaite, Mark D Schwartz, Herbert Lepor, H Ballentine Carter, Erica Sedlander

Department of Urology, New York University, NY, USA. ., Population Health, New York University, NY, USA., Department of Population Health Sciences, University of Utah, Salt Lake City, UT., Department of Urology, New York University, NY, USA., Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD.

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