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Murphy AB, Abern MR, Liu L, Wang H, Hollowell CMP, Sharifi R, Vidal P, Kajdacsy-Balla A, Sekosan M, Ferrer K, Wu S, Gallegos M, King-Lee P, Sharp LK, Ferrans CE, Gann PH. Impact of a Genomic Test on Treatment Decision in a Predominantly African American Population With Favorable-Risk Prostate Cancer: A Randomized Trial. J Clin Oncol 2021; 39:1660-1670. [PMID: 33835822 PMCID: PMC8148420 DOI: 10.1200/jco.20.02997] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The Genomic Prostate Score (GPS), performed on biopsy tissue, predicts adverse outcome in prostate cancer (PCa) and has shown promise for improving patient selection for active surveillance (AS). However, its impact on treatment choice in high-risk populations of African Americans is largely unknown and, in general, the effect of the GPS on this difficult decision has not been evaluated in randomized trials. METHODS Two hundred men with National Comprehensive Cancer Network very low to low-intermediate PCa from three Chicago hospitals (70% Black, 16% college graduates) were randomly assigned at diagnosis to standard counseling with or without a 12-gene GPS assay. The primary end point was treatment choice at a second postdiagnosis visit. The proportion of patients choosing AS was compared, and multivariable modeling was used to estimate the effects of various factors on AS acceptance. RESULTS AS acceptance was high overall, although marginally lower in the intervention group (77% v 88%; P = .067), and lower still when men with inadequate specimens were excluded (P = .029). Men with lower health literacy who received a GPS were seven-fold less likely to choose AS compared with controls, whereas no difference was seen in men with higher health literacy (Pinteraction = .022). Among men with low-intermediate risk, 69% had GPS values consistent with unfavorable intermediate or high-risk cancer. AS choice was also independently associated with a family history of PCa and having health insurance. CONCLUSION In contrast to other studies, the net effect of the GPS was to move patients away from AS, primarily among men with low health literacy. These findings have implications for our understanding of how prognostic molecular assays that generate probabilities of poor outcome can affect treatment decisions in diverse clinical populations.
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Affiliation(s)
- Adam B. Murphy
- Department of Urology, Northwestern University, Chicago, IL
- Division of Urology, Cook County Health and Hospital System, Chicago, IL
- Department of Urology, Jesse Brown VA Medical Center, Chicago, IL
| | - Michael R. Abern
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Li Liu
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | - Heidy Wang
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | | | | | - Patricia Vidal
- Division of Urology, Cook County Health and Hospital System, Chicago, IL
| | | | - Marin Sekosan
- Department of Pathology, Cook County Health and Hospital System, Chicago, IL
| | - Karen Ferrer
- Department of Pathology, Cook County Health and Hospital System, Chicago, IL
| | - Shoujin Wu
- Pathology and Laboratory Services, Jesse Brown VA Medical Center, Chicago, IL
| | - Marlene Gallegos
- Pathology and Laboratory Services, Jesse Brown VA Medical Center, Chicago, IL
| | - Patrice King-Lee
- Department of Pathology, University of Illinois at Chicago, Chicago, IL
| | - Lisa K. Sharp
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Carol E. Ferrans
- Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL
| | - Peter H. Gann
- Department of Pathology, University of Illinois at Chicago, Chicago, IL
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2
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Filson CP, Hong F, Xiong N, Pozzar R, Halpenny B, Berry DL. Decision support for men with prostate cancer: Concordance between treatment choice and tumor risk. Cancer 2020; 127:203-208. [PMID: 33119142 DOI: 10.1002/cncr.33241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Decision support tools improve decisional conflict and elicit patient preferences related to prostate cancer treatment. It was hypothesized that men using the Personal Patient Profile-Prostate (P3P) would be more likely to pursue guideline-concordant treatment. METHODS Men from a trial assessing the P3P decision support intervention were identified. The primary exposure was allocation to P3P (vs usual care), and the outcome was appropriate treatment per guidelines (eg, low risk = active surveillance). It was assessed whether providers recommended against any treatment options (ie, restricted). A multivariable model was fit for men with low-risk cancer that estimated the odds of the outcome of interest. RESULTS This study identified 295 men in the cohort: 113 (38%) had low-risk disease, 119 (40%) had favorable intermediate-risk disease, and 63 (21%) had unfavorable intermediate-risk disease. Among low-risk patients, more men pursued active surveillance after using P3P whether they were given unrestricted (62% vs 54% with usual care; P = .54) or restricted options (71% vs 59% with usual care; P = .34). After adjustments, only Black race (odds ratio [OR], 0.31; 95% CI, 0.11-0.89) and restricted options (OR, 0.23; 95% CI, 0.08-0.65) had an inverse association with the receipt of surveillance for patients with low-risk prostate cancer. An impact associated with P3P versus usual care (OR, 0.89; 95% CI, 0.36-2.20) was not observed. CONCLUSIONS Among men in a trial assessing a decision support tool, Black race and restricted treatment options were associated with less use of active surveillance for low-risk prostate cancer. Although the P3P instrument ameliorates decisional conflict, its use was not associated with more appropriate alignment of treatment with disease risk.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia.,Department of Urology, Atlanta VA Medical Center, Decatur, Georgia
| | - Fangxin Hong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Barbara Halpenny
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.,Department of Urology, University of Washington, Seattle, Washington
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3
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Selman LE, Clement C, Ochieng CA, Lewis AL, Chapple C, Abrams P, Drake MJ, Horwood J. Treatment decision-making among men with lower urinary tract symptoms: A qualitative study of men's experiences with recommendations for patient-centred practice. Neurourol Urodyn 2020; 40:201-210. [PMID: 33053240 DOI: 10.1002/nau.24533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
AIMS To inform and guide patient-centred care for men with lower urinary tract symptoms (LUTS), by providing in-depth qualitative evidence regarding men's perspectives on treatment decision-making for LUTS. METHODS An interview study of men recruited from 26 English urology departments. Purposive sampling captured surgical/nonsurgical treatment decisions, and diversity in demographics and symptom burden, in men who had urodynamics and those who did not. After diagnostic assessments, men were interviewed either pre-treatment or after LUTS surgery. Thematic analysis was conducted. Participants' descriptions of how LUTS treatment decisions were made were categorised as patient-led, doctor-led, or shared. RESULTS A total of 41 men participated (25 pre-treatment, 16 post-surgery), ages 52-89. Twenty out of 41 described the treatment decision as shared with their consultant, 14 as doctor-led, and seven as patient-led. There was no obvious association between treatment decision-making style and patients' satisfaction with either clinicians' role in their decision or their treatment decision. Incomplete or rushed discussions and misperceptions of LUTS and its treatment were reported, indicating a risk of suboptimal decision-making support by clinicians. As well as clinician opinion, men's treatment decision-making was influenced by the results of urological assessments, comparing current symptoms with possible side-effects of surgery, and others' experiences and opinions. CONCLUSIONS Men with LUTS report and prefer different kinds of decision-making support from their clinicians, who must tailor their input to patients' preferences and needs. Patients' treatment decision-making involves multiple factors and can be challenging, and areas of inadequate clinician support were identified. Recommendations for patient-centred consultations about LUTS treatment are presented.
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Affiliation(s)
- Lucy E Selman
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cynthia A Ochieng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda L Lewis
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christopher Chapple
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK.,Translational Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
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4
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Holm S, Kristiansen TB, Ploug T. Control, trust and the sharing of health information: the limits of trust. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105887. [PMID: 32843438 DOI: 10.1136/medethics-2019-105887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/06/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
Clinical information about patients is increasingly being stored in electronic form and has therefore become more easily shareable. Data are collected as part of clinical care but have multiple other potential uses in relation to health system planning, audit and research. The use of clinical information for these secondary uses is controversial, and the ability to safeguard personal and sensitive data under current practices is contested.In this study, we investigate the attitudes of a representative sample of the Danish population towards transfer of clinical data from their general practice for secondary use. We specifically study: (1) patients' trust in different types of healthcare professionals, (2) their interest in being asked about secondary use of data and (3) their willingness to dispense from a requirement of informed consent based on their trust in healthcare professionals.We find that adult Danes are positive towards research that use patient data, and they generally trust general practitioners, hospitals and researchers to treat their data confidentially.Nevertheless, they feel that they have a right to control the use of their data, only 7.3% disagreeing, and that the data belong to them, only 14.0% disagreeing. Answers to further questions about the relation between trust, information and consent show that although trust modifies the wish for information and consent, there is still a strong view that the patient should control the use of data. We find no differences between those who have frequent contact with the healthcare system and those who do not.
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Affiliation(s)
- Soren Holm
- Department of Law, University of Manchester, Manchester, UK
- Center for Medical Ethics, HELSAM, University of Oslo Faculty of Medicine, Oslo, Norway
| | | | - Thomas Ploug
- Centre for Applied Ethics and Philosophy of Science, Aalborg University Copenhagen, København S, Denmark
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5
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Palmer Kelly E, Meara A, Hyer M, Payne N, Pawlik TM. Characterizing Perceptions Around the Patient-Oncologist Relationship: a Qualitative Focus Group Analysis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:447-453. [PMID: 30772927 DOI: 10.1007/s13187-019-1481-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of the current study was to characterize the experiences of cancer patients and their caregiver/family members around their relationship with their oncologist, health care team, and the hospital environment. Participants were recruited from The Ohio State University Comprehensive Cancer Center. Participant sociodemographic factors were assessed. Focus groups were moderated and recorded by two members of the research team using a semi-structured interview format. The audio recordings were transcribed and uploaded to NViVO 11 for analyses. Four focus groups were conducted with 25 participants. The mean age of participants was 58.4 years (SD = 15.1, range 26.0-76.0). Participants who were identified as patients (84%) reported different malignancy types including breast (56%), gynecologic (16%), skin (6%) oral (6%), and non-Hodgkin's lymphoma (6%). Three major themes that emerged around the patient-oncologist relationship, include (1) choosing a physician and health care location, (2) relationship with the physician, health care team, and hospital environment; and (3) patient engagement and decision-making. Subthemes highlighted the importance of the flexible communication behaviors and trustworthiness of the oncologist, and the impact of other health care team members. Patients also reported the desire to be engaged in making treatment-related decisions and to include the caregiver/spouse in all stages of cancer care. Understanding the experience of cancer patients in a relationship with their oncologist in the context of the health care team and health care environment will be an important area of future research to provide optimal, tailored patient-centered cancer care.
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Affiliation(s)
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolette Payne
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Ho AS, Daskivich TJ, Sacks WL, Zumsteg ZS. Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review. JAMA Oncol 2020; 5:556-564. [PMID: 30543358 DOI: 10.1001/jamaoncol.2018.5321] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Across many countries, a rapid escalation of the incidence of thyroid cancer has been observed, a surge that nonetheless underestimates the true extent of the disease. Most thyroid cancers now diagnosed comprise small, low-risk cancers that are incidentally found and are unlikely to cause harm. In many ways, prostate cancer similarly harbors a well-behaved subclinical reservoir, a long natural history, and superlative outcomes that have made active surveillance the de facto guideline recommendation for low-risk disease. This review highlights the parallels and differences between prostate cancer and thyroid cancer regarding screening, diagnosis, risk stratification, and considerations for active surveillance. Observations Prostate cancer and thyroid cancer have undergone recalibrated, de-escalatory shifts to counter changing epidemiologic landscapes. The US Preventive Services Task Force has issued cautionary recommendations on screening via prostate-specific antigen testing or neck ultrasonography, while the thresholds to performing biopsy have increased. Comparable changes to cancer terminology and staging have also helped alleviate patient anxiety and minimize pressure for overtreatment. Long-term, randomized prospective clinical trials for prostate cancer have established active surveillance as a first-line treatment approach for properly stratified low-risk patients, while observational trials for thyroid cancer have also made strides in defining risk and eligibility for surgery. Caveats requiring deeper investigation include aggressive disease in older patients, underestimation of the extent of the disease, and patient-physician bias in shared decision making. For prostate cancer, survival may not improve and function will likely worsen after intervention; for thyroid cancer, patients are younger, surgery is safer, and the bar for surveillance will likely be higher. Conclusions and Relevance Despite similarities in biological indolence between low-risk prostate and thyroid malignant neoplasms, key distinctions in life expectancy and treatment sequelae may ultimately confer somewhat disparate management paradigms for the 2 diseases. Nevertheless, the experience forged by prostate cancer trials serves as a model for thyroid cancer management, potentially reshaping the perception of active surveillance into a credible, valuable treatment modality.
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Affiliation(s)
- Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Timothy J Daskivich
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wendy L Sacks
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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7
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Hoffman RM, Lobo T, Van Den Eeden SK, Davis KM, Luta G, Leimpeter AD, Aaronson D, Penson DF, Taylor K. Selecting Active Surveillance: Decision Making Factors for Men with a Low-Risk Prostate Cancer. Med Decis Making 2019; 39:962-974. [PMID: 31631745 DOI: 10.1177/0272989x19883242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Men with a low-risk prostate cancer (PCa) should consider observation, particularly active surveillance (AS), a monitoring strategy that avoids active treatment (AT) in the absence of disease progression. Objective. To determine clinical and decision-making factors predicting treatment selection. Design. Prospective cohort study. Setting. Kaiser Permanente Northern California (KPNC). Patients. Men newly diagnosed with low-risk PCa between 2012 and 2014 who remained enrolled in KPNC for 12 months following diagnosis. Measurements. We used surveys and medical record abstractions to measure sociodemographic and clinical characteristics and psychological and decision-making factors. Men were classified as being on observation if they did not undergo AT within 12 months of diagnosis. We performed multivariable logistic regression analyses. Results. The average age of the 1171 subjects was 61.5 years (s = 7.2 years), and 81% were white. Overall, 639 (57%) were managed with observation; in adjusted analyses, significant predictors of observation included awareness of low-risk status (odds ratio 1.75; 95% confidence interval 1.04-2.94), knowing that observation was an option (3.62; 1.62-8.09), having concerns about treatment-related quality of life (1.21, 1.09-1.34), reporting a urologist recommendation for observation (8.20; 4.68-14.4), and having a lower clinical stage (T1c v. T2a, 2.11; 1.16-3.84). Conversely, valuing cancer control (1.54; 1.37-1.72) and greater decisional certainty (1.66; 1.18-2.35) were predictive of AT. Limitations. Results may be less generalizable to other types of health care systems and to more diverse populations. Conclusions. Many participants selected observation, and this was associated with tumor characteristics. However, nonclinical decisional factors also independently predicted treatment selection. Efforts to provide early decision support, particularly targeting knowledge deficits, and reassurance to men with low-risk cancers may facilitate better decision making and increase uptake of observation, particularly AS.
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Affiliation(s)
- Richard M Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Kimberly M Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - David Aaronson
- Department of Urology, Kaiser Permanente East Bay, Oakland, CA, USA
| | - David F Penson
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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8
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What Do Primary Healthcare Providers and Complementary and Alternative Medicine Practitioners in Palestine Need to Know about Exercise for Cancer Patients and Survivors: A Consensual Study Using the Delphi Technique. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:7695818. [PMID: 31118968 PMCID: PMC6500610 DOI: 10.1155/2019/7695818] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/22/2019] [Accepted: 04/14/2019] [Indexed: 12/24/2022]
Abstract
Background Exercise has physiologic and psychological benefits for cancer patients and survivors. Today, various exercises are recommended as adjunct to therapies for cancer patients and survivors. This study was conducted to develop a consensual core list of important knowledge items that primary healthcare providers and complementary and alternative medicine (CAM) practitioners need to know on the role of exercises and physical activities in stimulating anticancer immunity. Methods Knowledge items were collected following interviews with key contact experts (4 oncologists, 3 exercise and medicine specialists, 2 researchers, 2 cancer patients, and 3 survivors) and extensive literature review. The collected knowledge items were rated by 9 researchers who conducted research on exercise and cancer. A modified two-iterative Delphi technique was employed among a panel (n = 65) of healthcare providers and CAM practitioners to develop the consensual core list of knowledge items. Results Of the 49 knowledge items, consensus was achieved on 45 (91.8%) items in 6 categories. Of those, 9 (20.0%) were general items on recommending moderate to vigorous habitual exercises and physical activities. The rest of items were related to the effects of habitual exercises and physical activities on the functions of immune system and exposure to carcinogens 16 (35.6%), anticancer therapies 12 (26.7%), metastasis of cancer 3 (6.7%), metabolism within tumors 3 (6.7%), and myokines release 2 (4.4%). Conclusion Formal consensus was achieved for the first time on a core list of knowledge items on how exercises and physical activities might stimulate anticancer immunity. This core list might be considered at the time of developing training/educational interventions and/or continuing education for primary healthcare providers and CAM practitioners. Future studies are still needed to investigate if such consensual lists might improve congruence in cancer care continuum and improve survival rates and wellbeing of cancer patients and survivors.
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Fritz Z, Holton R. Too much medicine: not enough trust? JOURNAL OF MEDICAL ETHICS 2019; 45:31-35. [PMID: 30367013 PMCID: PMC6327867 DOI: 10.1136/medethics-2018-104866] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/05/2018] [Accepted: 09/16/2018] [Indexed: 06/08/2023]
Abstract
As many studies around the theme of 'too much medicine' attest, investigations are being ordered with increasing frequency; similarly the threshold for providing treatment has lowered. Our contention is that trust (or lack of it) is a significant factor in influencing this, and that understanding the relationship between trust and investigations and treatments will help clinicians and policymakers ensure ethical decisions are more consistently made. Drawing on the philosophical literature, we investigate the nature of trust in the patient-doctor relationship, arguing that at its core it involves a transfer of discretion. We show that there is substantial empirical support for the idea that more trust will reduce the problem of too much medicine. We then investigate ways in which trust can be built, concentrating on issues of questioning, of acknowledging uncertainty and of shouldering responsibility for it. We argue that offering investigations or treatments as a way of generating trust may itself be an untrustworthy way of proceeding, and that healthcare systems should provide the institutional support for facilitating continuity, questioning and the entrusting of uncertainty.
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Affiliation(s)
- Zoë Fritz
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
- The Division of Health Sciences, Warwick Medical School, Coventry, UK
| | - Richard Holton
- Faculty of Philosophy, University of Cambridge, Cambridge, UK
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10
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Palmer Kelly E, Agne JL, Hyer M, Meara A, Olsen G, Pawlik TM. A systematic review of the methods utilised to measure the relationship between cancer patients and oncologists: Implications for future research and practice. Eur J Cancer Care (Engl) 2018; 28:e12981. [PMID: 30561074 DOI: 10.1111/ecc.12981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/13/2018] [Accepted: 11/18/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The patient-physician relationship is a critical component of patient-centred health care. The patient-oncologist relationship is particularly important due to the uncertainties that surround treatment of cancer. The goal of the current review was to summarise current methodological approaches to studying the relationship between cancer patients and oncologists. METHODS A systematic review using PsychInfo, Ebsco, PubMed and Google Scholar was performed using combinations and variations of the MESH terms: "relationship," "doctor-patient," and "oncology." The included studies explicitly measured the "relationship" as an independent or dependent variable. Data were extracted and analysed. RESULTS The 13 studies included in the review were published from 2004 to 2018. There was little agreement between studies on the definition of the patient-oncologist relationship. Trust was most frequently measured, but methods varied. Most studies evaluated the patient perspective (n = 10). The few studies that considered the oncologist perspective did not measure their perception of the relationship. CONCLUSIONS The current review demonstrates that current approaches used to assess the patient-oncologist relationship are inconsistent. These differences may limit our understanding of patient needs in current research and practice. Future research should focus on the use of a relational lens as a theoretical framework to assess the patient-oncologist relationship.
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Affiliation(s)
| | - Julia L Agne
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Griffin Olsen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Abstract
Patients with cancer may report neuropsychiatric abnormalities including cognitive impairment, behavioral disturbances, and psychiatric disorders that potentially worsen their quality of life, reduce their treatment response, and aggravate their overall prognosis. Neuropsychiatric disturbances have a different pathophysiology, including immuno-inflammatory and neuroendocrine mechanisms, as a consequence of oncologic treatments (chemo- and radio-therapy). Among clinicians involved in the management of such patients, psychiatrists need to pay particular attention in recognizing behavioral disturbances that arise in oncologic patients, and determining those that may be effectively treated with psychotropic medications, psychotherapeutic interventions, and an integration of them. Through the contribution of different clinicians actively involved in the management of oncological patients, the present review is ultimately aimed at updating psychiatrists in relation to the pathophysiological mechanisms responsible for the onset of cognitive, affective, and behavioral syndromes in these patients, along with epidemiologic and clinical considerations and therapeutic perspectives.
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12
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Náfrádi L, Kostova Z, Nakamoto K, Schulz PJ. The doctor-patient relationship and patient resilience in chronic pain: A qualitative approach to patients' perspectives. Chronic Illn 2018; 14:256-270. [PMID: 29096534 DOI: 10.1177/1742395317739961] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To study patients' perspectives about the role of the doctor-patient relationship in promoting the resilience process. METHODS We conducted in-depth interviews with 20 chronic pain patients. Using open-ended questions, the interviews explored aspects of the doctor-patient relationship that impacted the patients' perceptions of their resilience. Thematic analysis built on an inductive, adaptive approach to data coding was employed to organize a representation of key factors affecting resilience. RESULTS The themes emerging from the interviews inform us about how the different aspects of the doctor-patient relationship can promote patient resilience in chronic pain. Three main themes emerged: the doctor providing psychological support, promoting patients' health literacy related to chronic pain and its treatment, and empowering the patients to cooperate in finding the right treatment. This fosters patients' direct outcomes (feeling validated, health literate, and empowered), which, in turn, lead to adaptive coping responses and day-to-day disease management. These direct outcomes are crucial for patients to maintain socially and personally meaningful activities and their functional (physical) capacity. DISCUSSION A doctor-patient relationship following the precepts of the patient-centered care is a significant resource that can lead to increased patient resilience. Thus, future interventions promoting patient resilience might consider addressing the doctor-patient relationship.
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Affiliation(s)
- Lilla Náfrádi
- 1 Institute of Communication and Health, Universita della Svizzera Italiana, Università della Svizzera Italiana, Lugano, Switzerland
| | - Zlatina Kostova
- 2 Department of Psychiatry, University of Massachusetts Medical School, Worcester, USA
| | - Kent Nakamoto
- 1 Institute of Communication and Health, Universita della Svizzera Italiana, Università della Svizzera Italiana, Lugano, Switzerland
| | - Peter J Schulz
- 1 Institute of Communication and Health, Universita della Svizzera Italiana, Università della Svizzera Italiana, Lugano, Switzerland
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Andkhoie M, Meyer D, Szafron M. Factors underlying treatment decision-making for localized prostate cancer in the U.S. and Canada: A scoping review using principal component analysis. Can Urol Assoc J 2018; 13:E220-E225. [PMID: 30472985 DOI: 10.5489/cuaj.5538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this research is to gather, collate, and identify key factors commonly studied in localized prostate cancer (LPC) treatment decision-making in Canada and the U.S. METHODS This scoping review uses five databases (Medline, EMBASE, CINAHL, AMED, and PsycInfo) to identify relevant articles using a list of inclusion and exclusion criteria applied by two reviewers. A list of topics describing the themes of the articles was extracted and key factors were identified using principal component analysis (PCA). A word cloud of titles and abstracts of the relevant articles was created to identify complementary results to the PCA. RESULTS This review identified 77 relevant articles describing 32 topics related to LPC treatment decision-making. The PCA grouped these 32 topics into five key factors commonly studied in LPC treatment decision-making: 1) treatment type; 2) socioeconomic/demographic characteristics; 3) personal reasons for treatment choice; 4) psychology of treatment decision experience; and 5) level of involvement in the decision-making process. The word cloud identified common phrases that were complementary to the factors identified through the PCA. CONCLUSIONS This research identifies several possible factors impacting LPC treatment decision-making. Further research needs to be completed to determine the impact that these factors have in the LPC treatment decision-making experience.
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Affiliation(s)
- Mustafa Andkhoie
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Desneige Meyer
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
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de Mik SML, Stubenrouch FE, Balm R, Ubbink DT. Systematic review of shared decision-making in surgery. Br J Surg 2018; 105:1721-1730. [PMID: 30357815 PMCID: PMC6282808 DOI: 10.1002/bjs.11009] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/08/2018] [Accepted: 09/05/2018] [Indexed: 12/21/2022]
Abstract
Background Multiple treatment options are generally available for most diseases. Shared decision‐making (SDM) helps patients and physicians choose the treatment option that best fits a patient's preferences. This review aimed to assess the extent to which SDM is applied during surgical consultations, and the metrics used to measure SDM and SDM‐related outcomes. Methods This was a systematic review of observational studies and clinical trials that measured SDM during consultations in which surgery was a treatment option. Embase, MEDLINE and CENTRAL were searched. Study selection, quality assessment and data extraction were conducted by two investigators independently. Results Thirty‐two articles were included. SDM was measured using nine different metrics. Thirty‐six per cent of 13 176 patients and surgeons perceived their consultation as SDM, as opposed to patient‐ or surgeon‐driven. Surgeons more often perceived the decision‐making process as SDM than patients (43·6 versus 29·3 per cent respectively). SDM levels scored objectively using the OPTION and Decision Analysis System for Oncology instruments ranged from 7 to 39 per cent. Subjective SDM levels as perceived by surgeons and patients ranged from 54 to 93 per cent. Patients experienced a higher level of SDM during consultations than surgeons (93 versus 84 per cent). Twenty‐five different SDM‐related outcomes were reported. Conclusion At present, SDM in surgery is still in its infancy, although surgeons and patients both think of it favourably. Future studies should evaluate the effect of new interventions to improve SDM during surgical consultations, and its assessment using available standardized and validated metrics. Heterogeneous data
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Affiliation(s)
- S M L de Mik
- Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F E Stubenrouch
- Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R Balm
- Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Kinsella N, Stattin P, Cahill D, Brown C, Bill-Axelson A, Bratt O, Carlsson S, Van Hemelrijck M. Factors Influencing Men's Choice of and Adherence to Active Surveillance for Low-risk Prostate Cancer: A Mixed-method Systematic Review. Eur Urol 2018; 74:261-280. [PMID: 29598981 PMCID: PMC6198662 DOI: 10.1016/j.eururo.2018.02.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Despite support for active surveillance (AS) as a first treatment choice for men with low-risk prostate cancer (PC), this strategy is largely underutilised. OBJECTIVE To systematically review barriers and facilitators to selecting and adhering to AS for low-risk PC. EVIDENCE ACQUISITION We searched PsychINFO, PubMed, Medline 2000-now, Embase, CINAHL, and Cochrane Central databases between 2002 and 2017 using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The Purpose, Respondents, Explanation, Findings and Significance (PREFS) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) quality criteria were applied. Forty-seven studies were identified. EVIDENCE SYNTHESIS Key themes emerged as factors influencing both choice and adherence to AS: (1) patient and tumour factors (age, comorbidities, knowledge, education, socioeconomic status, family history, grade, tumour volume, and fear of progression/side effects); (2) family and social support; (3) provider (speciality, communication, and attitudes); (4) healthcare organisation (geography and type of practice); and (5) health policy (guidelines, year, and awareness). CONCLUSIONS Many factors influence men's choice and adherence to AS on multiple levels. It is important to learn from the experience of other chronic health conditions as well as from institutions/countries that are making significant headway in appropriately recruiting men to AS protocols, through standardised patient information, clinician education, and nationally agreed guidelines, to ultimately decrease heterogeneity in AS practice. PATIENT SUMMARY We reviewed the scientific literature for factors affecting men's choice and adherence to active surveillance (AS) for low-risk prostate cancer. Our findings suggest that the use of AS could be increased by addressing a variety of factors such as information, psychosocial support, clinician education, and standardised guidelines.
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Affiliation(s)
- Netty Kinsella
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK.
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Declan Cahill
- Department of Urology, The Royal Marsden Hospital, London, UK
| | | | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden
| | - Sigrid Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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16
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Chen YY, Cheng YF, Wu CC, Chu TS. The usage of social media encouraged patients' active participation in medical decision-making: cross-sectional survey (Preprint). J Particip Med 2018. [DOI: 10.2196/11828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gordetsky JB, Saylor B, Bae S, Nix JW, Rais-Bahrami S. Prostate cancer management choices in patients undergoing multiparametric magnetic resonance imaging/ultrasound fusion biopsy compared to systematic biopsy. Urol Oncol 2018. [DOI: 10.1016/j.urolonc.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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18
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Patient and provider experiences with active surveillance: A scoping review. PLoS One 2018; 13:e0192097. [PMID: 29401514 PMCID: PMC5798833 DOI: 10.1371/journal.pone.0192097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/23/2017] [Indexed: 01/03/2023] Open
Abstract
Objective Active surveillance (AS) represents a fundamental shift in managing select cancer patients that initiates treatment only upon disease progression to avoid overtreatment. Given uncertain outcomes, patient engagement could support decision-making about AS. Little is known about how to optimize patient engagement for AS decision-making. This scoping review aimed to characterize research on patient and provider communication about AS, and associated determinants and outcomes. Methods MEDLINE, EMBASE, CINAHL, and The Cochrane Library were searched from 2006 to October 2016. English language studies that evaluated cancer patient or provider AS views, experiences or behavioural interventions were eligible. Screening and data extraction were done in duplicate. Summary statistics were used to describe study characteristics and findings. Results A total of 2,078 studies were identified, 1,587 were unique, and 1,243 were excluded based on titles/abstracts. Among 344 full-text articles, 73 studies were eligible: 2 ductal carcinoma in situ (DCIS), 4 chronic lymphocytic leukemia (CLL), 6 renal cell carcinoma (RCC) and 61 prostate cancer. The most influential determinant of initiating AS was physician recommendation. Others included higher socioeconomic status, smaller tumor size, comorbid disease, older age, and preference to avoid adverse treatment effects. AS patients desired more information about AS and reassurance about future treatment options, involvement in decision-making and assessment of illness uncertainty and supportive care needs during follow-up. Only three studies of prostate cancer evaluated interventions to improve AS communication or experience. Conclusions This study revealed a paucity of research on AS communication for DCIS, RCC and CLL, but generated insight on how to optimize AS discussions in the context of routine care or clinical trials from research on AS for prostate cancer. Further research is needed on AS for patients with DCIS, RCC and CLL, and to evaluate interventions aimed at patients and/or providers to improve AS communication, experience and associated outcomes.
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La relation soignant–soigné dans la littérature académique : tendances générales, limites et perspectives futures. ANNALES MEDICO-PSYCHOLOGIQUES 2018. [DOI: 10.1016/j.amp.2017.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Fitch M, Pang K, Ouellet V, Loiselle C, Alibhai S, Chevalier S, Drachenberg DE, Finelli A, Lattouf JB, Sutcliffe S, So A, Tanguay S, Saad F, Mes-Masson AM. Canadian Men's perspectives about active surveillance in prostate cancer: need for guidance and resources. BMC Urol 2017; 17:98. [PMID: 29078772 PMCID: PMC5658971 DOI: 10.1186/s12894-017-0290-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 10/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background In prostate cancer, men diagnosed with low risk disease may be monitored through an active surveillance. This research explored the perspectives of men with prostate cancer regarding their decision-making process for active surveillance to identify factors that influence their decision and assist health professionals in having conversations about this option. Methods Focus group interviews (n = 7) were held in several Canadian cities with men (N = 52) diagnosed with prostate cancer and eligible for active surveillance. The men’s viewpoints were captured regarding their understanding of active surveillance, the factors that influenced their decision, and their experience with the approach. A content and theme analysis was performed on the verbatim transcripts from the sessions. Results Patients described their concerns of living with their disease without intervention, but were reassured by the close monitoring under AS while avoiding harmful side effects associated with treatments. Conversations with their doctor and how AS was described were cited as key influences in their decision, in addition to availability of information on treatment options, distrust in the health system, personality, experiences and opinions of others, and personal perspectives on quality of life. Conclusions Men require a thorough explanation on AS as a safe and valid option, as well as guidance towards supportive resources in their decision-making.
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Affiliation(s)
- Margaret Fitch
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada
| | - Kittie Pang
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada
| | - Veronique Ouellet
- Institut du cancer de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St Denis St, Montreal, QC, Canada
| | - Carmen Loiselle
- McGill University and McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada
| | - Shabbir Alibhai
- University Health Network, 610 University Ave, Toronto, ON, Canada
| | - Simone Chevalier
- McGill University and McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada
| | | | - Antonio Finelli
- University Health Network, 610 University Ave, Toronto, ON, Canada
| | - Jean-Baptiste Lattouf
- Institut du cancer de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St Denis St, Montreal, QC, Canada.,Department of Surgery Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC, Canada
| | - Simon Sutcliffe
- Terrry Fox Research Institute, 675 West 10th Avenue, Vancouver, BC, Canada
| | - Alan So
- Vancouver Prostate Centre, 2660 Oak St, Vancouver, BC, Canada
| | - Simon Tanguay
- McGill University and McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada
| | - Fred Saad
- Institut du cancer de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St Denis St, Montreal, QC, Canada. .,Department of Surgery Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC, Canada.
| | - Anne-Marie Mes-Masson
- Institut du cancer de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St Denis St, Montreal, QC, Canada.,Department of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC, Canada
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21
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Renzi C, Fioretti C, Oliveri S, Mazzocco K, Zerini D, Alessandro O, Rojas DP, Jereczek-Fossa BA, Pravettoni G. A Qualitative Investigation on Patient Empowerment in Prostate Cancer. Front Psychol 2017; 8:1215. [PMID: 28798701 PMCID: PMC5526923 DOI: 10.3389/fpsyg.2017.01215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/03/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose: Men with prostate cancer often describe low levels of empowerment. eHealth interventions may represent useful tools to deliver care and education and to meet patients' needs within an empowerment framework. In order to design a platform for cancer patients' empowerment within the H2020 iManageCancer project, the perspective of the target population for the platform was assessed. The present study aims to assess the qualitative experience of prostate cancer patients during treatment in order to provide insights for clinical practice with a particular focus on the design of a web platform to promote cancer patients' empowerment. Methods: Ten patients undergoing radiation therapy treatment took part in a semi-structured interview to explore different aspects of patient empowerment. Four main thematic areas were addressed: patient-healthcare providers' communication, decision-making, needs, and resources. A qualitative approach using thematic analysis was followed. Results: Half of the patients reported little to no possibility to share information and questions with healthcare providers. With regards to decision-making, the role of healthcare providers was perceived as directive/informative, but half of the patients perceived to assume an active role in at least one interaction. Difficulties and needs included the choice of the specialist or of the structure after diagnosis, clinicians' support in self-management, surgical consequences, and side effects, preparation for radiation therapy. Resources included family and social support both from a practical and from an emotional perspective, coping style, and work schedule management. Conclusions: These results suggest that relations with healthcare providers should be supported, especially immediately after diagnosis and after surgery. Support to self-management after surgery and at the beginning of radiation therapy treatment also constitutes a priority. The adoption of a personalized approach from the beginning of prostate cancer care flow may promote patient empowerment, overcoming the aforementioned needs and mobilizing resources. The social network represents an important resource that could be integrated in interventions. These considerations will be taken into account in the design of a cancer self-management platform aiming to increase patients' empowerment.
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Affiliation(s)
- Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Chiara Fioretti
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Serena Oliveri
- Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy
| | - Ombretta Alessandro
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Damaris P Rojas
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
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22
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Rocque GB, Halilova KI, Varley AL, Williams CP, Taylor RA, Masom DG, Wright WJ, Partridge EE, Kvale EA. Feasibility of a Telehealth Educational Program on Self-Management of Pain and Fatigue in Adult Cancer Patients. J Pain Symptom Manage 2017; 53:1071-1078. [PMID: 28185891 PMCID: PMC8641243 DOI: 10.1016/j.jpainsymman.2016.12.345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/12/2016] [Accepted: 12/29/2016] [Indexed: 02/08/2023]
Abstract
CONTEXT Pain and fatigue are common symptoms among cancer patients and often lead to substantial distress. Innovative self-management programs for pain and fatigue are needed. OBJECTIVES The primary objective was to assess the feasibility of a telehealth pain and fatigue self-management program among adult cancer patients. Secondary objectives included assessment of differences in patient characteristics, recruitment, and retention of patients based on two screening strategies: 1) navigator-collected, patient-reported pain or fatigue and 2) in-clinic, physician-identified pain or fatigue. METHODS This prospective, nonrandomized, pre-post evaluation assessed feasibility, which was defined as 50% of eligible patients choosing to participate and completing the intervention. Patient demographics and patient-reported outcomes (patient activation, distress, symptoms, and quality of life) were collected at baseline and study completion. Differences in baseline characteristics were compared between cohorts and for patients who did vs. did not graduate from the program. RESULTS The program did not meet feasibility requirements because of only 34% of eligible patients choosing to participate. However, 50% of patients starting the program graduated. Differences in baseline characteristics and retention rates were noted by recruitment strategy. At baseline, 27.3% of navigated patients were at the highest activation level compared with 7.1% in the physician-referred, non-navigated patients (P = 0.17); more than 15% of non-completers were at the lowest activation level compared with 9% of completers (P = 0.85). CONCLUSION Telehealth self-management program for pain and fatigue may be better accepted among selected segments of cancer patients. Larger scale studies are needed to assess the efficacy of this program in a more selective activated population.
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Affiliation(s)
- Gabrielle B Rocque
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Karina I Halilova
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allyson L Varley
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Edward E Partridge
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth A Kvale
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mallapareddi A, Ruterbusch J, Reamer E, Eggly S, Xu J. Active surveillance for low-risk localized prostate cancer: what do men and their partners think? Fam Pract 2017; 34:90-97. [PMID: 28034917 PMCID: PMC6916739 DOI: 10.1093/fampra/cmw123] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Active surveillance (AS) is recognized as a reasonable treatment option for low-risk localized prostate cancer (LPC) but continues to be chosen by a minority of men. To date, limited data are available regarding reasons why men with low-risk LPC adopt AS. PURPOSE The aim of this study is to better understand conceptualizations, experiences and reasons why men with low-risk LPC and their partners adopt AS. METHODS We conducted five focus groups (FGs), three among men with low-risk LPC who had chosen AS and two with their partners. FGs were video/audio recorded, transcribed and analysed using qualitative thematic analysis. RESULTS A total of 12 men and 6 partners (all women) participated in FG discussions. The most common reasons for choosing AS were seeing the LPC as 'small' or 'low grade' without need for immediate treatment and trusting their physician's AS recommendation. The most common concerns about AS were perceived unreliability of prostate specific antigen, pain associated with prostate biopsies and potential cancer progression. Partners saw themselves as very involved in their husbands' treatment decision-making process, more than men acknowledged them to be. Multiple terms including 'watchful waiting' were used interchangeably with AS. There appeared to be a lack of understanding that AS is not simply 'doing nothing' but is actually a recognized management option for low-risk LPC. CONCLUSIONS Emphasizing the low risk of a man's LPC and enhancing physician trust may increase acceptability of AS. Standardizing terminology and presenting AS as a reasonable and recognized management option may also help increase its adoption.
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Affiliation(s)
- Arun Mallapareddi
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA and
| | - Julie Ruterbusch
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Elyse Reamer
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA and
| | - Susan Eggly
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Jinping Xu
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA and
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Orom H, Underwood W, Cheng Z, Homish DL, Scott I. Relationships as Medicine: Quality of the Physician-Patient Relationship Determines Physician Influence on Treatment Recommendation Adherence. Health Serv Res 2016; 53:580-596. [PMID: 27981559 DOI: 10.1111/1475-6773.12629] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether quality of physician-patient relationships influences uptake of physician treatment recommendations in men with clinically localized prostate cancer (PCa). STUDY SETTING Data were collected July 2010 to August 2014 at two cancer centers and three community facilities. STUDY DESIGN Analyses were prospective and cross-sectional. We modeled associations between quality of the patient-physician relationship and influence of physician recommendations on treatment choice using generalized estimating equations (GEE). DATA COLLECTION Data were collected via survey and medical record abstraction. PRINCIPAL FINDINGS Participants (N = 1166) were 14.7 percent minority; 37.1 percent had low-, 47.5 percent had intermediate-, and 15.4 percent had high-risk PCa. Those reporting a better physician-patient relationship perceived that their physician's treatment recommendation was more influential (RR = 1.05, 95 percent CI = 1.04-1.05, p < .001) and were more likely to choose the recommended treatment (OR = 2.92, 95 percent CI = 2.39, 3.58, p < .001). A pattern of interactions emerged indicating that quality of the physician-patient relationship was more strongly associated with influence of recommendations for more, versus less aggressive treatment in those with low-risk, but not intermediate-risk disease. CONCLUSIONS Prioritizing quality of the physician-patient relationship through training, practice change, and patient feedback may increase adherence. However, strategies need to align with efforts to reduce physician recommendations for inefficacious treatments to prevent overtreatment.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Zinan Cheng
- Touro College of Osteopathic Medicine, Middletown, NY
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - I'Yanna Scott
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
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25
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Moschini M, Fossati N, Sood A, Lee JK, Sammon J, Sun M, Pucheril D, Dalela D, Montorsi F, Karnes RJ, Briganti A, Trinh QD, Menon M, Abdollah F. Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance: A North American Population-based Study. Eur Urol Focus 2016; 4:68-74. [PMID: 28753764 DOI: 10.1016/j.euf.2016.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 05/21/2016] [Accepted: 06/02/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Active surveillance (AS) is increasingly recognized as a recommended treatment option for prostate cancer (PCa) patients with clinically localized, low-risk disease; however, previous studies suggested that its utilization is uncommon in the United States. OBJECTIVE We evaluated the nationwide utilization rate of AS in the contemporary era. DESIGN, SETTING, AND PARTICIPANTS We relied on the 2010-2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9049 patients that fulfilled the University of California, San Francisco AS criteria (prostate-specific antigen level <10ng/ml, clinical T stage ≤2a, Gleason score ≤6 [no pattern 4 or 5], and percentage of positive biopsy cores <33%). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression analysis tested the relationship between receiving local treatment and all available predictors. RESULTS AND LIMITATIONS Only 32% of AS candidates did not receive any active local treatment. This proportion varied widely among the SEER-based registries, ranging from 13% to 49% (p<0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; p=0.04) and percentage of positive cores (OR: 1.10 for each 2% increase; p<0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; p<0.001), not being married (OR: 0.64; p<0.001), and uninsured status (OR: 0.55; p=0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. CONCLUSIONS In the United States, a considerable proportion of patients suitable for AS receive local treatment for PCa. Proportions differ significantly among SEER registries. PATIENT SUMMARY Having more extensive and palpable disease, having medical insurance, being married, and being younger are associated with an increased probability of receiving local treatment for low-risk prostate cancer.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy; Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Nicola Fossati
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Akshay Sood
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Justin K Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jesse Sammon
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Dan Pucheril
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Deepansh Dalela
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Francesco Montorsi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | | | - Alberto Briganti
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Quoc-Dien Trinh
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Mani Menon
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Firas Abdollah
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA.
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Abstract
PURPOSE OF REVIEW Treatment decisions for low-risk prostate cancer are arguably some of the most challenging in oncology. Active surveillance has emerged as an important option for many men with tumors estimated to have a low metastatic potential. Multiple complex patient and physician factors affect the recommendation, selection, and adherence to active surveillance. While baseline clinical criteria are used to identify candidates for this approach, it is important to identify and understand other forces that may influence the management of prostate cancer with active surveillance. RECENT FINDINGS Patient perceptions and acceptance of active surveillance have improved over time. Treatment decisions for prostate cancer are strongly associated with physician recommendations, and a high-quality relationship between the patient and his healthcare system is critical to successful active surveillance. Patient understanding of prostate cancer and consistency of information received from separate physicians can affect a decision to pursue active surveillance. Psychological symptoms, most notably regarding anxiety and distress, can affect adherence to active surveillance over time. In general, anxiety for men on active surveillance is low, and lifestyle interventions and self-management strategies may be helpful for increasing quality of life and limiting abandonment of active surveillance in the absence of disease progression. SUMMARY Multiple factors may affect the decision for and adherence to active surveillance for prostate cancer. It is important for both physicians and patients to be aware of these issues and work towards individualized approaches and interventions as needed to increase adoption of active surveillance in the future.
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Danzig MR, McKiernan JM. Overtreatment of men with early-stage prostate cancer and limited life expectancy. Cancer 2014; 120:3592-4. [PMID: 25042257 DOI: 10.1002/cncr.28927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/30/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew R Danzig
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
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