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Otrebski Nilsson M, Aas K, Myklebust TÅ, Gjelsvik YM, Haug ES, Fosså SD, Johannesen TB. Do all prostate cancer patients want, and experience shared decision making prior to curative treatment? Scand J Urol 2023; 58:133-140. [PMID: 38116675 DOI: 10.2340/sju.v58.14730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/23/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE In comparable men with non-metastatic prostate cancer, radical prostatectomy (RP), radiotherapy (RAD) and active surveillance (AS) are treatment options with similar survival rates, but different side-effects. Healthcare professionals consider pretreatment shared decision making (SDM) to be an essential part of medical care, though the patients' view about SDM is less known. In this article, we explore prostate cancer (PCa) patients' SDM wish (SDMwish), and experiences (SDMexp). Material and methods: This is a registry-based survey performed by the Cancer Registry of Norway (2017-2019). One year after diagnosis, 5,063 curatively treated PCa patients responded to questions about their pre-treatment wish and experience regarding SDM. Multivariable analyses identified factors associated with SDM. Statistical significance level: p < 0.05. Results: Overall, 78% of the patients wished to be involved in SDM and 83% of these had experienced SDM. SDMwish and SDMexp was significantly associated with decreasing age, increasing education, and living with a partner. Compared with the RP group, the probability of SDMwish and SDMexp was reduced by about 40% in the RAD and the AS groups. Conclusion: Three of four curatively treated PCa wanted to participate in SDM, and this wish was met in four of five men. Younger PCa patients with higher education in a relationship, and opting for RP, wanted an active role in SDM, and experienced being involved. Effective SDM requires the responsible physicians' attention to the individual patients' characteristics and needs.
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Affiliation(s)
- Mona Otrebski Nilsson
- Cancer Registry of Norway, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Kirsti Aas
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | - Tor Å Myklebust
- Cancer Registry of Norway, Oslo, Norway; Department of Research, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | | | - Erik Skaaheim Haug
- Cancer Registry of Norway, Oslo, Norway; Department of Urology Vestfold Hospital Trust, Tønsberg, Norway; Institute of Cancer Genomics and Informatics Oslo University Hospital, Oslo, Norway
| | - Sophie D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
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Ihrig A, Maatouk I, Friederich HC, Baunacke M, Groeben C, Koch R, Thomas C, Huber J. The Treatment Decision-making Preferences of Patients with Prostate Cancer Should Be Recorded in Research and Clinical Routine: a Pooled Analysis of Four Survey Studies with 7169 Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:675-682. [PMID: 32940881 PMCID: PMC9205804 DOI: 10.1007/s13187-020-01867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 05/13/2023]
Abstract
Different patients want to take different roles in the treatment decision-making process; these roles can be classified as passive, collaborative, and active. The aim of this study was to investigate the correlation between decision-making preferences among patients with prostate cancer and personal, disease-related, and structural factors. In four survey studies, we asked 7169 prostate cancer patients about their decision-making preferences using the Control Preferences Scale (CPS) and collected clinical, psychological, and quality-of-life measures. Most patients (62.2%) preferred collaborative decision-making, while 2322 (32.4%) preferred an active role, and only 391 (5.5%) preferred a passive role. Age (p < 0.001), data collection mode (p < 0.001), peer-to-peer support (p = 0.018), treatment status (p < 0.001), performed or planned radical prostatectomy (p < 0.001), metastatic disease (p = 0.001), and quality of life (p < 0.001) showed significant associations with patients' preferred decision-making roles. Oncologic risk group, anxiety, and depression were not significant in the model. In particular, younger prostate cancer patients with higher quality of life completing an online survey want to play a more active role in treatment decision-making. Before treatment has started, patients tend to prefer collaborative decision-making. Few prostate cancer patients in Germany prefer a passive role. These patients are mostly older patients, patients with a metastatic disease, and patients who have opted for prostatectomy. Whether this finding reflects a generational effect or a tendency by age group and disease phase should be investigated. Further research is also needed to describe the causalities of these relationships. The CPS offers valuable information for personal counselling and should be applied in clinical routine. In a large group of patients with prostate cancer, we found that there is a strong desire for joint decision-making with the physician before the actual treatment. Especially younger men, men with active online behaviour, and men with a high quality of life want to be actively involved in therapy decision-making processes.
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Affiliation(s)
- Andreas Ihrig
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - I Maatouk
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - H C Friederich
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - M Baunacke
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - C Groeben
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Koch
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - C Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - J Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Haste A, Lambert M, Sharp L, Thomson R, Sowden S. Patient experiences of the urgent cancer referral pathway-Can the NHS do better? Semi-structured interviews with patients with upper gastrointestinal cancer. Health Expect 2020; 23:1512-1522. [PMID: 32989907 PMCID: PMC7752202 DOI: 10.1111/hex.13136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Timeliness is viewed as a key feature of health‐care quality. Internationally, this is challenging. In England, cancer waiting time targets are currently not being met. For example, between 2015 and 2018 only 71% of patients with upper gastrointestinal (UGI) cancer started treatment within the recommended 62 days of referral. Objective We explored patients’ experiences to identify areas for service improvement. Design Semi‐structured interviews were conducted. Setting and participants Twenty patients who were referred through the urgent (two‐week) GP referral route and were within six months of receiving first treatment were recruited. Data analysis Data from the interviews were analysed thematically. Results Four themes were developed: organization of care; diagnosis; support; and views and expectations of the NHS. Patients described cross‐cutting issues such as complex and varied pathways and uncertainty about what would happen next. They felt daunted by the intensity and speed of investigations. They were presented with a recommended course of action rather than options and had little involvement in decision making. They were grateful for care, reluctant to complain and resigned to the status quo. Discussion and conclusions In order to meet patient needs, the NHS needs to improve communication and streamline pathways. Future cancer pathways also need to be designed to support shared decision making, be truly person‐centred and informed by patient experience.
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Affiliation(s)
- Anna Haste
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Mark Lambert
- Public Health England, North East Centre, Newcastle, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Pham AP, Berman JS, Lewin RK. Does involving patients in treatment decisions affect perceptions of treatments and therapists? Psychother Res 2019; 30:487-494. [DOI: 10.1080/10503307.2019.1620368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Alice P. Pham
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | | | - Rivian K. Lewin
- Department of Psychology, University of Memphis, Memphis, TN, USA
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Mansfield E, Bryant J, Carey M, Turon H, Henskens F, Grady A. Getting the right fit: Convergence between preferred and perceived involvement in treatment decision making among medical oncology outpatients. Health Sci Rep 2019; 2:e101. [PMID: 30697595 PMCID: PMC6346985 DOI: 10.1002/hsr2.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/04/2018] [Accepted: 10/08/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND AIMS While cancer patients' preferences for their level of involvement in treatment decision making (TDM) vary, previous research indicates a large proportion of patients are not experiencing TDM that meets their preferences. Evidence is needed to identify the characteristics of cancer patients who are less likely to report experiencing their preferred level of involvement in TDM, so that appropriate decision-making support can be provided to them. We examined in a sample of medical oncology outpatients (1) the level of agreement between preferred and perceived involvement in TDM and (2) demographic, psychological, disease, and treatment characteristics associated with having unmet preferences for involvement in TDM. METHODS AND RESULTS Cancer patients from three medical oncology treatment centers in Australia completed surveys assessing demographic, disease and treatment variables, psychological distress, and preferred and perceived involvement in TDM. Data were collected between February 2013 and December 2014. Factors associated with having unmet TDM preferences were examined using logistic regression. There were 355 patients included in the analysis (75% response rate). The mean age (±SD) of the participants was 61 (±12), and 45% were male. Overall, 60% of participants reported that their preferences for involvement in TDM were met. No demographic, psychological, disease, or treatment characteristics were significantly associated with an increased probability of not having TDM preferences met. CONCLUSIONS In line with previous research, a large proportion (40%) of patients reported TDM experiences that were not in alignment with their preferences. Future research should explore additional characteristics that are associated with a lower likelihood of having TDM preferences met.
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Affiliation(s)
- Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Heidi Turon
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Frans Henskens
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Alice Grady
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
- Population Health, Hunter New England Local Health DistrictWallsendAustralia
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Taggar AS, Martell K, Husain S, Peacock M, Sia M, Gotto G. Exposure to radiation and medical oncology training: A survey of Canadian urology residents and fellows. Can Urol Assoc J 2018; 12:321-325. [PMID: 29989919 DOI: 10.5489/cuaj.5147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Residency experiences and teaching in oncology among urology residents are variable across Canada. We sought to identify how radiation and medical oncology concepts, as they pertain to genitourinary malignancies, are taught to urology residents. METHODS A total of 190 trainees enrolled in Canadian urology residency training programs were invited to participate in the study from January 2016 to June 2016. Participants completed an online questionnaire addressing the training they received. RESULTS The overall response rate was 32%. Twenty-three percent of respondents were in their fellowship year; 17%, 20%, 10%, 17%, and 12% were first-, second-, third-, fourth-, and fifth-year residents, respectively, with a median of four (range 1-9) respondents from each training program. Ninety-five percent of respondents had academic half-day (AHD) as part of their training that included radiotherapy (61%) and chemotherapy (51%) teaching. Most respondents indicated their main exposure to chemotherapy and radiation came from informal teaching in urology clinics. Twenty-nine percent and 41%, of participants had mandatory rotations in radiation and medical oncology, respectively. Only 6% of respondents used their voluntary elective time in these disciplines and most voluntary electives were of 1-2-week duration. Despite this, 90% of respondents preferred some mandatory radiation and medical oncology training. CONCLUSIONS Most of the limited exposure that urology residents have to medical and radiation oncology is through AHD or informal urology clinics, despite a desire among current urology trainees to have clinical exposure in these areas. Moving forward, urology residency programs should consider integrating medical and radiation oncology rotations into the residency program curriculum.
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Affiliation(s)
- Amandeep S Taggar
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Kevin Martell
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Siraj Husain
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Michael Peacock
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Michael Sia
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Geoffrey Gotto
- Department of Surgery, Division of Urology, University of Calgary, Calgary, AB, Canada
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