男性对前列腺癌筛查的看法：定性研究的系统评价

Men's perspectives of prostate cancer screening: A systematic review of qualitative studies.

作者信息

James Laura J, Wong Germaine, Craig Jonathan C, Hanson Camilla S, Ju Angela, Howard Kirsten, Usherwood Tim, Lau Howard, Tong Allison

机构信息

Sydney School of Public Health, The University of Sydney, Sydney, Australia.

Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.

出版信息

PLoS One. 2017 Nov 28;12(11):e0188258. doi: 10.1371/journal.pone.0188258. eCollection 2017.

DOI:10.1371/journal.pone.0188258

PMID:29182649

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5705146/

Abstract

BACKGROUND

Prostate cancer is the most commonly diagnosed non-skin cancer in men. Screening for prostate cancer is widely accepted; however concerns regarding the harms outweighing the benefits of screening exist. Although patient's play a pivotal role in the decision making process, men may not be aware of the controversies regarding prostate cancer screening. Therefore we aimed to describe men's attitudes, beliefs and experiences of prostate cancer screening.

METHODS

Systematic review and thematic synthesis of qualitative studies on men's perspectives of prostate cancer screening. Electronic databases and reference lists were searched to October 2016.

FINDINGS

Sixty studies involving 3,029 men aged from 18-89 years, who had been screened for prostate cancer by Prostate Specific Antigen (PSA) or Digital Rectal Examination (DRE) and not screened, across eight countries were included. Five themes were identified: Social prompting (trusting professional opinion, motivation from family and friends, proximity and prominence of cancer); gaining decisional confidence (overcoming fears, survival imperative, peace of mind, mental preparation, prioritising wellbeing); preserving masculinity (bodily invasion, losing sexuality, threatening manhood, medical avoidance); avoiding the unknown and uncertainties (taboo of cancer-related death, lacking tangible cause, physiological and symptomatic obscurity, ambiguity of the procedure, confusing controversies); and prohibitive costs.

CONCLUSIONS

Men are willing to participate in prostate cancer screening to prevent cancer and gain reassurance about their health, particularly when supported or prompted by their social networks or healthcare providers. However, to do so they needed to mentally overcome fears of losing their masculinity and accept the intrusiveness of screening, the ambiguities about the necessity and the potential for substantial costs. Addressing the concerns and priorities of men may facilitate informed decisions about prostate cancer screening and improve patient satisfaction and outcomes.

摘要

背景

前列腺癌是男性中最常被诊断出的非皮肤癌。前列腺癌筛查已被广泛接受；然而，对于筛查的危害大于益处的担忧依然存在。尽管患者在决策过程中起着关键作用，但男性可能并未意识到前列腺癌筛查存在的争议。因此，我们旨在描述男性对前列腺癌筛查的态度、信念和经历。

方法

对关于男性对前列腺癌筛查观点的定性研究进行系统综述和主题综合分析。检索电子数据库及参考文献列表至2016年10月。

结果

纳入了八项研究，涉及来自八个国家的3029名年龄在18至89岁之间的男性，这些男性接受过前列腺特异性抗原（PSA）或直肠指检（DRE）前列腺癌筛查或未接受过筛查。确定了五个主题：社会推动（信任专业意见、家人和朋友的激励、癌症的临近和突出）；获得决策信心（克服恐惧、生存必要性、安心、心理准备、优先考虑健康）；维护男子气概（身体侵犯、失去性能力、威胁男子身份、避免医疗）；避免未知和不确定性（癌症相关死亡的禁忌、缺乏明确病因、生理和症状的模糊性、检查程序的不明确、令人困惑的争议）；以及费用过高。

结论

男性愿意参与前列腺癌筛查以预防癌症并获得健康方面的安心，特别是在其社交网络或医疗服务提供者的支持或推动下。然而，要做到这一点，他们需要在心理上克服对失去男子气概的恐惧，并接受筛查的侵入性、必要性的模糊性以及高昂费用的可能性。解决男性的担忧和优先事项可能有助于就前列腺癌筛查做出明智决策，并提高患者满意度和治疗效果。