Shen Megan Johnson, Nelson Christian J, Peters Ellen, Slovin Susan F, Hall Simon J, Hall Matt, Herrera Phapichaya Chaoprang, Leventhal Elaine A, Leventhal Howard, Diefenbach Michael A
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY (MJS, CJN)
Department of Psychology, Ohio State University, Columbus, OH (EP)
Med Decis Making. 2015 May;35(4):477-86. doi: 10.1177/0272989X14558424. Epub 2014 Nov 10.
Prostate cancer survivors with a rising prostate-specific antigen (PSA) level have few treatment options, experience a heightened state of uncertainty about their disease trajectory that might include the possibility of cancer metastasis and death, and often experience elevated levels of distress as they have to deal with a disease they thought they had conquered. Guided by self-regulation theory, the present study examined the cognitive and affective processes involved in shared decision making between physicians and patients who experience a rising PSA after definitive treatment for prostate cancer.
In-depth interviews were conducted with 34 prostate cancer survivors who had been diagnosed with a rising PSA (i.e., biochemical failure) within the past 12 months. Survivors were asked about their experiences and affective responses after being diagnosed with a rising PSA and while weighing potential treatment options. In addition, patients were asked about their decision-making process for the initial prostate cancer treatment.
Compared with the initial diagnosis, survivors with a rising PSA reported increased negative affect following their diagnosis, concern about the treatability of their disease, increased planning and health behavior change, heightened levels of worry preceding doctor appointments (especially prior to the discussion of PSA testing results), and a strong reliance on physicians' treatment recommendations.
Prostate cancer survivors' decision-making processes for the treatment of a rising PSA are markedly different from those of the initial diagnosis of prostate cancer. Because patients experience heightened distress and rely more heavily on their physicians' recommendations with a rising PSA, interactions with the health care provider provide an excellent opportunity to address and assist patients with managing the uncertainty and distress inherent with rising PSA levels.
前列腺特异性抗原（PSA）水平升高的前列腺癌幸存者几乎没有治疗选择，他们对疾病发展轨迹的不确定性增加，这可能包括癌症转移和死亡的可能性，而且由于不得不应对他们原本以为已经战胜的疾病，他们常常感到极度痛苦。本研究以自我调节理论为指导，探讨了前列腺癌根治性治疗后PSA水平升高的患者与医生共同决策过程中涉及的认知和情感过程。
对34名在过去12个月内被诊断为PSA升高（即生化复发）的前列腺癌幸存者进行了深入访谈。询问幸存者在被诊断为PSA升高后以及权衡潜在治疗方案时的经历和情感反应。此外，还询问了患者最初前列腺癌治疗的决策过程。
与初次诊断相比，PSA升高的幸存者报告称，诊断后负面情绪增加，对疾病可治疗性的担忧增加，规划和健康行为改变增多，在看医生之前（尤其是在讨论PSA检测结果之前）担忧程度加剧，并且强烈依赖医生的治疗建议。
前列腺癌幸存者对PSA升高进行治疗的决策过程与前列腺癌初次诊断时明显不同。由于PSA升高时患者会感到更大的痛苦，并且更严重地依赖医生的建议，因此与医疗服务提供者的互动为解决和帮助患者应对PSA水平升高所固有的不确定性和痛苦提供了绝佳机会。
