Menichetti Julia, Valdagni Riccardo, Bellardita Lara
Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy.
Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Italy.
Transl Androl Urol. 2018 Feb;7(1):160-169. doi: 10.21037/tau.2017.12.34.
Several studies have been conducted on the quality of life (QoL) in men with low risk prostate cancer (PCa) who choose active surveillance (AS). While recent reviews have shown a lack of consistency among the available QoL-studies, a few key points have been identified, including decision-making (DM)-related issues and their potential effect on QoL. The importance of this theme has also been recently highlighted by the international task force of the European School of Oncology. However, to our knowledge, there are no studies that have specifically marshalled scientific knowledge on the association between DM and QoL among men with low-risk PCa undergoing AS. We performed a literature review to fill this gap, taking a systematic approach to retrieving and selecting articles that included both DM and QoL measures. Among the 272 articles retrieved, we selected nine observational, quantitative articles with both DM and QoL measures. The most considered DM aspects within these studies were decisional conflict and preference for the patient's role in the DM process, as well as health-related QoL aspects. The studies included 42 assessments of the relationship between an empirical measure of DM and an empirical measure of QoL. Among these assessments, 23 (55%) were both positive and significant. They mostly concerned the relationship between patient-related (decisional self-efficacy, decisional control and knowledge) and external (presence of social support, collaborative role within the DM process, and influence of different physicians) DM aspects, as well as the QoL after choice. The findings of these studies revealed key challenges to research and clinical practice related to DM and QoL in AS. These include adopting a person-centred perspective where clinicians, caregivers and their interactions are also included in evaluations and where the psychosocial existential experience of individuals within the DM and AS journey is considered. Much more attention needs to be paid to the DM process after diagnosis, as well as to all the other moments where patients may have to or want to review their decision. Healthcare professionals play a key role in enabling men to make informed decisions and to take care of their health and well-being during AS. There is still work that needs to be done in training healthcare professionals from different disciplines to work together in a model of shared DM and AS tailored to the needs of low-risk PCa patients and their family members.
针对选择主动监测（AS）的低风险前列腺癌（PCa）男性的生活质量（QoL），已经开展了多项研究。尽管近期的综述表明现有QoL研究之间缺乏一致性，但已确定了一些关键点，包括决策（DM）相关问题及其对QoL的潜在影响。欧洲肿瘤学院国际特别工作组最近也强调了这一主题的重要性。然而，据我们所知，尚无研究专门整理关于接受AS的低风险PCa男性中DM与QoL之间关联的科学知识。我们进行了一项文献综述以填补这一空白，采用系统方法检索和选择包含DM和QoL测量的文章。在检索到的272篇文章中，我们选择了9篇同时具有DM和QoL测量的观察性定量文章。这些研究中最常考虑的DM方面是决策冲突、患者在DM过程中对自身角色的偏好以及与健康相关的QoL方面。这些研究包括42项对DM实证测量与QoL实证测量之间关系的评估。在这些评估中，23项（55%）呈正向且显著。它们大多涉及患者相关（决策自我效能、决策控制和知识）和外部（社会支持的存在、DM过程中的协作角色以及不同医生的影响）DM方面与选择后的QoL之间的关系。这些研究结果揭示了与AS中DM和QoL相关的研究及临床实践面临的关键挑战。这些挑战包括采用以患者为中心的视角，在评估中纳入临床医生、护理人员及其互动，同时考虑个体在DM和AS过程中的心理社会生存体验。诊断后的DM过程以及患者可能必须或想要重新审视其决策的所有其他时刻，都需要给予更多关注。医疗保健专业人员在使男性能够做出明智决策并在AS期间照顾好自己的健康和福祉方面发挥着关键作用。在培训来自不同学科的医疗保健专业人员以共同参与为低风险PCa患者及其家庭成员量身定制的共享DM和AS模式方面，仍有工作要做。
