Men considering a hypothetical treatment for prostate cancer: a comparison to patients

Framing Options as Choice or Opportunity

Objective. Health professionals must enable patients to make informed decisions about health care choices through unbiased presentation of all options. This study examined whether presenting the decision as “opportunity” rather than “choice” biased individuals’ preferences in the context of trial participation for cancer treatment. Methods. Self-selecting healthy women ( N = 124) were randomly assigned to the following decision frames: opportunity to take part in the trial (opt-in), opportunity to be removed from the trial (opt-out), and choice to have standard treatment or take part in the trial (choice). The computer-based task required women to make a hypothetical choice about a real-world cancer treatment trial. The software presented the framed scenario, recorded initial preference, presented comprehensive and balanced information, traced participants’ use of information during decision making, and recorded final decision. A posttask paper questionnaire assessed perceived risk, attitudes, subjective norm, perceived behavioral control, and satisfaction with decision. Results. Framing influenced women’s immediate preferences. Opportunity frames, whether opt-in or opt-out, introduced a bias as they discouraged women from choosing standard treatment. Using the choice frame avoided this bias. The opt-out opportunity frame also affected women’s perceived social norm; women felt that others endorsed the trial option. The framing bias was not present once participants had had the opportunity to view detailed information on the options within a patient decision aid format. There were no group differences in information acquisition and final decisions. Sixteen percent changed their initial preference after receiving full information. Conclusions. A “choice” frame, where all treatment options are explicit, is less likely to bias preferences. Presentation of full information in parallel, option-by-attribute format is likely to “de-bias” the decision frame. Tailoring of information to initial preferences would be ill-advised as preferences may change following detailed information.

The relationship between prostate cancer knowledge and beliefs and intentions to attend PSA screening among at-risk men

OBJECTIVE

To examine the level of knowledge regarding prostate cancer and screening, to investigate prostate cancer illness perceptions, and to test the efficacy of the theory of planned behaviour (TPB) for understanding intentions to attend prostate-specific antigen (PSA) screening, when offered by a doctor or self-initiated.

METHODS

Two hundred and twenty three men completed the PROCASE knowledge scale, the Revised Illness Perceptions Questionnaire and a questionnaire developed to assess attitudes, subjective norms and perceived control over intentions to attend for PSA testing.

RESULTS

Participants had a high level of knowledge and accurate perceptions of prostate cancer. Controlling for knowledge and experience with prostate cancer, the TPB accounted for 49% (p<0.001) of the variation in intentions to attend if recommended by a doctor.

CONCLUSION

The sample of at-risk men were characterised by good knowledge, accurate mental representation of prostate cancer, and positive beliefs towards the PSA test. Components of the TPB accounted for statistically significant amounts of variation in intentions to attend for testing.

PRACTICE IMPLICATIONS

Beliefs about prostate cancer do not appear to influence PSA testing intentions; healthcare providers' recommendations may have the strongest influence on decisions to attend for PSA testing.

Percent positive biopsy cores as a prognostic factor for prostate cancer treated with external beam radiation

OBJECTIVES

To examine the prognostic value of percent positive cores (PPC) in prostate cancer patients treated with external beam radiotherapy (RT).

METHODS

An institutional review board-approved, retrospective analysis was conducted on 814 patients treated with RT with or without hormonal therapy between 1984 and 2002. Percent positive cores (number of positive cores divided by total number of cores) was calculable for 591 patients with a median follow-up of 65 months. Univariate and multivariable analyses were performed using Kaplan-Meier and Cox proportional hazard methods relating PPC to other risk factors, biochemical/clinical disease-free survival (PSA-DFS), prostate cancer-specific survival (DSS), and overall survival (OS).

RESULTS

Percent positive cores was associated with stage, Gleason score (GS), pretreatment serum prostate-specific antigen (PSA) level, and use of adjunctive androgen suppression therapy. The 5-year PSA-DFS, DSS, and OS rates were 80%, 99%, and 91%, respectively, for patients with PPC less than 50%, compared with 56%, 94%, and 87% for patients with PPC 50% or greater (P <0.0001, <0.004, and <0.04, respectively). Multivariable analysis revealed that PPC, stage, GS, PSA, and androgen suppression therapy were all significantly associated with PSA-DFS, whereas only GS was associated with DSS and OS. For high, intermediate, and low-risk patients, 5-year PSA-DFS was 62% versus 39%, 80% versus 59%, and 90% versus 82% for PPC less than 50% versus PPC 50% or greater, respectively.

CONCLUSIONS

Percent positive cores predicts outcome of prostate cancer patients treated with RT, independently of other known prognostic factors. Percent positive cores may have particular use for further risk stratification within established clinical risk categories.