Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA.
Psychooncology. 2018 Jan;27(1):325-332. doi: 10.1002/pon.4469. Epub 2017 Jul 13.
To characterize decision-making processes and outcomes among men expressing early-treatment preferences for low-risk prostate cancer.
We conducted telephone surveys of men newly diagnosed with low-risk prostate cancer in 2012 to 2014. We analyzed subjects who had discussed prostate cancer treatment with a clinician and expressed a treatment preference. We asked about decision-making processes, including physician discussions, prostate-cancer knowledge, decision-making styles, treatment preference, and decisional conflict. We compared the responses across treatment groups with χ or ANOVA.
Participants (n = 761) had a median age of 62; 82% were white, 45% had a college education, and 35% had no comorbidities. Surveys were conducted at a median of 25 days (range 9-100) post diagnosis. Overall, 55% preferred active surveillance (AS), 26% preferred surgery, and 19% preferred radiotherapy. Participants reported routinely considering surgery, radiotherapy, and AS. Most were aware of their low-risk status (97%) and the option for AS (96%). However, men preferring active treatment (AT) were often unaware of treatment complications, including sexual dysfunction (23%) and urinary complications (41%). Most men (63%) wanted to make their own decision after considering the doctor's opinion, and about 90% reported being sufficiently involved in the treatment discussion. Men preferring AS had slightly more uncertainty about their decisions than those preferring AT.
Subjects were actively engaged in decision making and considered a range of treatments. However, we found knowledge gaps about treatment complications among those preferring AT and slightly more decisional uncertainty among those preferring AS, suggesting the need for early decision support.
描述表达对低危前列腺癌早期治疗偏好的男性的决策过程和结果。
我们在 2012 年至 2014 年期间对新诊断为低危前列腺癌的男性进行了电话调查。我们分析了与临床医生讨论过前列腺癌治疗并表达了治疗偏好的受试者。我们询问了决策过程，包括医生讨论、前列腺癌知识、决策风格、治疗偏好和决策冲突。我们通过 χ 或 ANOVA 比较了治疗组之间的反应。
参与者（n=761）的中位年龄为 62 岁；82%为白人，45%具有大学学历，35%无合并症。调查在诊断后中位数为 25 天（范围 9-100）进行。总体而言，55%的人偏好主动监测（AS），26%的人偏好手术，19%的人偏好放疗。参与者报告经常考虑手术、放疗和 AS。大多数人都知道自己的低危状况（97%）和 AS 的选择（96%）。然而，选择主动治疗（AT）的男性往往不知道治疗并发症，包括性功能障碍（23%）和尿失禁（41%）。大多数男性（63%）希望在考虑医生意见后自己做出决定，约 90%的人报告说他们充分参与了治疗讨论。选择 AS 的男性对自己的决定稍微感到不确定，比选择 AT 的男性略多。
受试者积极参与决策，并考虑了一系列治疗方案。然而，我们发现选择 AT 的男性对治疗并发症的知识存在差距，而选择 AS 的男性对决策的不确定性略高，这表明需要早期决策支持。
