Gartrell Benjamin A, Phalguni Angaja, Bajko Paulina, Mundle Suneel D, McCarthy Sharon A, Brookman-May Sabine D, De Solda Francesco, Jain Ruhee, Yu Ko Wellam, Ploussard Guillaume, Hadaschik Boris
Departments of Oncology and Urology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA.
Evidence Synthesis, Genesis Research Group, Newcastle upon Tyne, UK.
Eur Urol Oncol. 2024 Dec;7(6):1216-1227. doi: 10.1016/j.euo.2024.04.016. Epub 2024 May 13.
Treatment decision-making (TDM) for patients with localized (LPC) or locally advanced (LAPC) prostate cancer is complex, and post-treatment decision regret (DR) is common. The factors driving TDM or predicting DR remain understudied.
Two systematic literature reviews were conducted to explore the factors associated with TDM and DR.
Three online databases, select congress proceedings, and gray literature were searched (September 2022). Publications on TDM and DR in LPC/LAPC were prioritized based on the following: 2012 onward, ≥100 patients, journal article, and quantitative data. The Preferred Reporting Items Reviews and Meta-analyses guidelines were followed. Influential factors were those with p < 0.05; for TDM, factors described as "a decision driver", "associated", "influential", or "significant" were also included. The key factors were determined by number of studies, consistency of evidence, and study quality.
Seventy-five publications (68 studies) reported TDM. Patient participation in TDM was reported in 34 publications; overall, patients preferred an active/shared role. Of 39 influential TDM factors, age, ethnicity, external factors (physician recommendation most common), and treatment characteristics/toxicity were key. Forty-nine publications reported DR. The proportion of patients experiencing DR varied by treatment type: 7-43% (active surveillance), 12-57% (radical prostatectomy), 1-49% (radiotherapy), 28-49% (androgen-deprivation therapy), and 21-47% (combination therapy). Of 42 significant DR factors, treatment toxicity (sexual/urinary/bowel dysfunction), patient role in TDM, and treatment type were key.
The key factors impacting TDM were physician recommendation, age, ethnicity, and treatment characteristics. Treatment toxicity and TDM approach were the key factors influencing DR. To help patients navigate factors influencing TDM and to limit DR, a shared, consensual TDM approach between patients, caregivers, and physicians is needed.
We looked at factors influencing treatment decision-making (TDM) and decision regret (DR) in patients with localized or locally advanced prostate cancer. The key factors influencing TDM were doctor's recommendation, patient age/ethnicity, and treatment side effects. A shared, consensual TDM approach between patients and doctors was found to limit DR.
局限性（LPC）或局部晚期（LAPC）前列腺癌患者的治疗决策制定（TDM）很复杂，治疗后决策后悔（DR）很常见。驱动TDM或预测DR的因素仍未得到充分研究。
进行两项系统文献综述，以探索与TDM和DR相关的因素。
检索了三个在线数据库、精选的会议论文集和灰色文献（2022年9月）。基于以下标准对LPC/LAPC中关于TDM和DR的出版物进行优先排序：2012年以后、≥100名患者、期刊文章和定量数据。遵循《系统评价和Meta分析的首选报告项目》指南。有影响的因素是p<0.05的因素；对于TDM，还包括被描述为“决策驱动因素”“相关”“有影响”或“显著”的因素。关键因素由研究数量、证据一致性和研究质量决定。
75篇出版物（68项研究）报告了TDM。34篇出版物报告了患者参与TDM的情况；总体而言，患者倾向于积极/共享的角色。在39个有影响的TDM因素中，年龄、种族、外部因素（最常见的是医生建议）以及治疗特征/毒性是关键因素。49篇出版物报告了DR。经历DR的患者比例因治疗类型而异：7-43%（主动监测）、12-57%（根治性前列腺切除术）、1-49%（放疗）、28-49%（雄激素剥夺治疗）和21-47%（联合治疗）。在42个显著的DR因素中，治疗毒性（性/泌尿/肠道功能障碍）、患者在TDM中的角色以及治疗类型是关键因素。
影响TDM的关键因素是医生建议、年龄、种族和治疗特征。治疗毒性和TDM方法是影响DR的关键因素。为了帮助患者应对影响TDM并限制DR的因素，患者、护理人员和医生之间需要一种共享的、协商一致的TDM方法。
我们研究了影响局限性或局部晚期前列腺癌患者治疗决策制定（TDM）和决策后悔（DR）的因素。影响TDM的关键因素是医生建议、患者年龄/种族和治疗副作用。发现患者和医生之间共享的、协商一致的TDM方法可限制DR。
