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Loeb S, Sanchez Nolasco T, Byrne N, Allen L, Langford AT, Ravenell JE, Gomez SL, Washington SL, Borno HT, Griffith DM, Criner N. Qualitative Study on Internet Use and Care Impact for Black Men With Prostate Cancer. HEALTH EDUCATION & BEHAVIOR 2024; 51:359-366. [PMID: 38366884 DOI: 10.1177/10901981241228226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Black men have a greater risk of prostate cancer as well as worse quality of life and more decisional regret after prostate cancer treatment compared to non-Hispanic White men. Furthermore, patients with prostate cancer who primarily obtain information on the internet have significantly more decisional regret compared to other information sources. Our objective was to explore the perspectives of Black patients on the use and impact of the internet for their prostate cancer care. In 2022-2023, we conducted seven virtual focus groups with Black patients with prostate cancer (n = 22). Transcripts were independently analyzed by two experienced researchers using a constant comparative method. Online sources were commonly used by participants throughout their cancer journey, although informational needs varied over time. Patient factors affected use (e.g., physical health and experience with the internet), and family members played an active role in online information-seeking. The internet was used before and after visits to the doctor. Key topics that participants searched for online included nutrition and lifestyle, treatment options, and prostate cancer in Black men. Men reported many downstream benefits with internet use including feeling more empowered in decision-making, reducing anxiety about treatment and providing greater accountability for research. However, they also reported negative impacts such as feeling overwhelmed or discouraged sorting through the information to identify high-quality content that is personally relevant, as well as increased anxiety or loss of sleep from overuse. In summary, online sources have the potential to positively impact the cancer journey by reinforcing or supplementing information from health care providers, but can be harmful if the information is poor quality, not representative, or the internet is overused.
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Affiliation(s)
- Stacy Loeb
- New York University Langone Health, New York, NY, USA
- Manhattan Veterans Affairs, New York, NY, USA
| | | | | | - Laura Allen
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Hala T Borno
- University of California San Francisco, San Francisco, CA, USA
- Trial Library Inc., San Francisco, CA, USA
| | - Derek M Griffith
- Department of Health Management and Policy, Racial Justice Institute and Center for Men's Health Equity, Georgetown University, Washington, DC, USA
| | - Nickole Criner
- University of California San Francisco, San Francisco, CA, USA
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2
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Gartrell BA, Phalguni A, Bajko P, Mundle SD, McCarthy SA, Brookman-May SD, De Solda F, Jain R, Yu Ko W, Ploussard G, Hadaschik B. Influential Factors Impacting Treatment Decision-making and Decision Regret in Patients with Localized or Locally Advanced Prostate Cancer: A Systematic Literature Review. Eur Urol Oncol 2024:S2588-9311(24)00106-8. [PMID: 38744587 DOI: 10.1016/j.euo.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/06/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
CONTEXT Treatment decision-making (TDM) for patients with localized (LPC) or locally advanced (LAPC) prostate cancer is complex, and post-treatment decision regret (DR) is common. The factors driving TDM or predicting DR remain understudied. OBJECTIVE Two systematic literature reviews were conducted to explore the factors associated with TDM and DR. EVIDENCE ACQUISITION Three online databases, select congress proceedings, and gray literature were searched (September 2022). Publications on TDM and DR in LPC/LAPC were prioritized based on the following: 2012 onward, ≥100 patients, journal article, and quantitative data. The Preferred Reporting Items Reviews and Meta-analyses guidelines were followed. Influential factors were those with p < 0.05; for TDM, factors described as "a decision driver", "associated", "influential", or "significant" were also included. The key factors were determined by number of studies, consistency of evidence, and study quality. EVIDENCE SYNTHESIS Seventy-five publications (68 studies) reported TDM. Patient participation in TDM was reported in 34 publications; overall, patients preferred an active/shared role. Of 39 influential TDM factors, age, ethnicity, external factors (physician recommendation most common), and treatment characteristics/toxicity were key. Forty-nine publications reported DR. The proportion of patients experiencing DR varied by treatment type: 7-43% (active surveillance), 12-57% (radical prostatectomy), 1-49% (radiotherapy), 28-49% (androgen-deprivation therapy), and 21-47% (combination therapy). Of 42 significant DR factors, treatment toxicity (sexual/urinary/bowel dysfunction), patient role in TDM, and treatment type were key. CONCLUSIONS The key factors impacting TDM were physician recommendation, age, ethnicity, and treatment characteristics. Treatment toxicity and TDM approach were the key factors influencing DR. To help patients navigate factors influencing TDM and to limit DR, a shared, consensual TDM approach between patients, caregivers, and physicians is needed. PATIENT SUMMARY We looked at factors influencing treatment decision-making (TDM) and decision regret (DR) in patients with localized or locally advanced prostate cancer. The key factors influencing TDM were doctor's recommendation, patient age/ethnicity, and treatment side effects. A shared, consensual TDM approach between patients and doctors was found to limit DR.
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Affiliation(s)
- Benjamin A Gartrell
- Departments of Oncology and Urology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA.
| | - Angaja Phalguni
- Evidence Synthesis, Genesis Research Group, Newcastle upon Tyne, UK
| | - Paulina Bajko
- Evidence Synthesis, Genesis Research Group, Newcastle upon Tyne, UK
| | - Suneel D Mundle
- Global Medical Affairs, Janssen Research & Development, Raritan, NJ, USA
| | - Sharon A McCarthy
- Clinical Research Oncology, Janssen Research & Development, Raritan, NJ, USA
| | - Sabine D Brookman-May
- Clinical Research Oncology, Janssen Research & Development, Spring House, PA, USA; Ludwig-Maximilians-University, München, Germany
| | - Francesco De Solda
- Global Commercial Strategy Organization, Janssen Global Services, Raritan, NJ, USA
| | - Ruhee Jain
- Global Commercial Strategy Organization, Janssen Global Services, Raritan, NJ, USA
| | - Wellam Yu Ko
- University of British Columbia Men's Health Research Program, Vancouver, BC, Canada
| | | | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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Fanshawe JB, Wai-Shun Chan V, Asif A, Ng A, Van Hemelrijck M, Cathcart P, Challacombe B, Brown C, Popert R, Elhage O, Ahmed K, Brunckhorst O, Dasgupta P. Decision Regret in Patients with Localised Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2023; 6:456-466. [PMID: 36870852 DOI: 10.1016/j.euo.2023.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
CONTEXT Treatment choice for localised prostate cancer remains a significant challenge for patients and clinicians, with uncertainty over decisions potentially leading to conflict and regret. There is a need to further understand the prevalence and prognostic factors of decision regret to improve patient quality of life. OBJECTIVE To generate the best estimates for the prevalence of significant decision regret localised prostate cancer patients, and to investigate prognostic patient, oncological, and treatment factors associated with regret. EVIDENCE ACQUISITION We performed a systematic search of MEDLINE, Embase, and PsychINFO databases including studies evaluating the prevalence or patient, treatment, or oncological prognostic factors in localised prostate cancer patients. A pooled prevalence of significant regret was calculated with the formal prognostic factor evaluation conducted per factor identified. EVIDENCE SYNTHESIS Significant decision regret was present in a pooled 20% (95% confidence interval 16-23) of patients across 14 studies and 17883 patients. This was lower in active surveillance (13%), with little difference between those who underwent radiotherapy (19%) and those who underwent prostatectomy (18%). Evaluation of individual prognostic factors demonstrated higher regret in those with poorer post-treatment bowel, sexual, and urinary function; decreased involvement in the decision-making process; and Black ethnicity. However, evidence remains conflicting, with low or moderate certainty of findings. CONCLUSIONS A significant proportion of men experience decision regret after a localised prostate cancer diagnosis. Monitoring those with increased functional symptoms and improving patient involvement in the decision-making process through education and decision aids may reduce regret. PATIENT SUMMARY We looked at how common regret in treatment decisions is after treatment for early-stage prostate cancer and factors linked with this. We found that one in five regret their decision, with those who had experienced side effects or were less involved in the decision-making process more likely to have regret. By addressing these, clinicians could reduce regret and improve quality of life.
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Affiliation(s)
| | - Vinson Wai-Shun Chan
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK; Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Aqua Asif
- Division of Surgery and Interventional Sciences, University College London, London, UK; Royal Surrey NHS Foundation Trust, Surrey, UK
| | - Alexander Ng
- Division of Surgery and Interventional Sciences, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Christian Brown
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Rick Popert
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Oussama Elhage
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, King's Health Partners, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK; Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Khalifa University, Abu Dhabi, United Arab Emirates
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Prokar Dasgupta
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
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Murphy AB. An editorial on a comparison of care quality metrics between Black and White men with advanced prostate cancer in the IRONMAN registry. Cancer 2023; 129:2453-2455. [PMID: 37246344 DOI: 10.1002/cncr.34886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This editorial highlights key findings from the manuscript entitled "Experience with the US health care system for Black and White patients with advanced prostate cancer" in the Cancer journal. Namely, the Black men and White men recruited in US sites for the International Registry for Men with Advanced Prostate Cancer (IRONMAN) registry reported similar and mainly affirmative responses for health care quality metrics on a survey. In non-National Cancer Institute-designated centers, the care was actually worse for the White participants than for the Black participants. The study's results suggest that clinical trial enrollment may be a way to improve health care quality and eliminate disparities for Black men. Whether this healthcare quality benefit extends beyond the few IRONMAN recruitment sites where Black men were recruited or beyond a few measures of healthcare quality remains to be seen.
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Affiliation(s)
- Adam B Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Wolff I, Burchardt M, Gilfrich C, Peter J, Baunacke M, Thomas C, Huber J, Gillitzer R, Sikic D, Fiebig C, Steinestel J, Schifano P, Löbig N, Bolenz C, Distler FA, Huettenbrink C, Janssen M, Schilling D, Barakat B, Harke NN, Fuhrmann C, Manseck A, Wagenhoffer R, Geist E, Blair L, Pfitzenmaier J, Reinhardt B, Hoschke B, Burger M, Bründl J, Schnabel MJ, May M. Patients Regret Their Choice of Therapy Significantly Less Frequently after Robot-Assisted Radical Prostatectomy as Opposed to Open Radical Prostatectomy: Patient-Reported Results of the Multicenter Cross-Sectional IMPROVE Study. Cancers (Basel) 2022; 14:cancers14215356. [PMID: 36358775 PMCID: PMC9654391 DOI: 10.3390/cancers14215356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Patient’s regret (PatR) concerning the choice of therapy represents a crucial endpoint for treatment evaluation after radical prostatectomy (RP) for prostate cancer (PCA). This study aims to compare PatR following robot-assisted (RARP) and open surgical approach (ORP). A survey comprising perioperative-functional criteria was sent to 1000 patients in 20 German centers at a median of 15 months after RP. Surgery-related items were collected from participating centers. To calculate PatR differences between approaches, a multivariate regressive base model (MVBM) was established incorporating surgical approach and demographic, center-specific, and tumor-specific criteria not primarily affected by surgical approach. An extended model (MVEM) was further adjusted by variables potentially affected by surgical approach. PatR was based on five validated questions ranging 0−100 (cutoff >15 defined as critical PatR). The response rate was 75.0%. After exclusion of patients with laparoscopic RP or stage M1b/c, the study cohort comprised 277/365 ORP/RARP patients. ORP/RARP patients had a median PatR of 15/10 (p < 0.001) and 46.2%/28.1% had a PatR >15, respectively (p < 0.001). Based on the MVBM, RARP patients showed PatR >15 relative 46.8% less frequently (p < 0.001). Consensual decision making regarding surgical approach independently reduced PatR. With the MVEM, the independent impact of both surgical approach and of consensual decision making was confirmed. This study involving centers of different care levels showed significantly lower PatR following RARP.
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Affiliation(s)
- Ingmar Wolff
- Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence:
| | - Martin Burchardt
- Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
| | - Julia Peter
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Johannes Huber
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Department of Urology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Rolf Gillitzer
- Department of Urology, Klinikum Darmstadt, 64283 Darmstadt, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Christian Fiebig
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Julie Steinestel
- Department of Urology, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Paola Schifano
- Department of Urology, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Niklas Löbig
- Department of Urology, University Hospital Ulm, 89081 Ulm, Germany
| | - Christian Bolenz
- Department of Urology, University Hospital Ulm, 89081 Ulm, Germany
| | - Florian A. Distler
- Department of Urology, Paracelsus Medical University, 90419 Nuremberg, Germany
| | | | - Maximilian Janssen
- Department of Urology, Isarklinikum Hospital Munich, 80331 Munich, Germany
| | - David Schilling
- Department of Urology, Isarklinikum Hospital Munich, 80331 Munich, Germany
| | - Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, 41747 Viersen, Germany
| | - Nina N. Harke
- Department of Urology and Urologic Oncology, Hanover Medical School, 30625 Hanover, Germany
| | - Christian Fuhrmann
- Department of Urology and Urologic Oncology, Hanover Medical School, 30625 Hanover, Germany
| | - Andreas Manseck
- Department of Urology, Klinikum Ingolstadt, 85049 Ingolstadt, Germany
| | | | - Ekkehard Geist
- Department of Urology, Klinikum Neumarkt, 92318 Neumarkt Oberpfalz, Germany
| | - Lisa Blair
- Department of Urology, Klinikum Neumarkt, 92318 Neumarkt Oberpfalz, Germany
| | - Jesco Pfitzenmaier
- Department of Urology, Evangelical Hospital Bethel, University Hospital Ostwestfalen-Lippe of the University Bielefeld, 33611 Bielefeld, Germany
| | - Bettina Reinhardt
- Department of Urology, Evangelical Hospital Bethel, University Hospital Ostwestfalen-Lippe of the University Bielefeld, 33611 Bielefeld, Germany
| | - Bernd Hoschke
- Department of Urology and Pediatric Urology, Carl-Thiem-Klinikum Cottbus, 03048 Cottbus, Germany
| | - Maximilian Burger
- Department of Urology, Caritas - St. Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Johannes Bründl
- Department of Urology, Caritas - St. Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Marco J. Schnabel
- Department of Urology, Caritas - St. Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
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6
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Joyce DD, Wallis CJD, Huang LC, Hoffman KE, Zhao Z, Koyama T, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Kaplan SH, Greenfield S, Penson DF, Barocas DA. The Association Between Financial Toxicity and Treatment Regret in Men With Localized Prostate Cancer. JNCI Cancer Spectr 2022; 6:6762868. [PMID: 36255249 PMCID: PMC9731205 DOI: 10.1093/jncics/pkac071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Financial toxicity is emerging as an important patient-centered outcome and is understudied in prostate cancer patients. We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better evaluate the role of financial discussions in patient counseling. METHODS Utilizing the Comparative Effectiveness Analysis of Surgery and Radiation dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance for localized prostate cancer. Financial burden and treatment regret were assessed at 3- and 5-year follow-up. The association between financial burden and regret was assessed using multivariable longitudinal logistic regression controlling for demographic and disease characteristics, treatment, functional outcomes, and patient expectations. RESULTS Of the 2924 eligible patients, regret and financial burden assessments for 3- and/or 5-year follow-up were available for 81% (n = 2359). After adjustment for relevant covariates, financial burden from "finances in general" was associated with treatment regret at 3 years (odds ratio [OR] = 2.47, 95% confidence interval [CI] = 1.33 to 4.57; P = .004); however, this association was no longer statistically significant at 5-year follow-up (OR = 1.19, 95% CI = 0.56 to 2.54; P = .7). CONCLUSIONS In this population-based sample of men with localized prostate cancer, we observed associations between financial burden and treatment regret. Our findings suggest indirect treatment costs, especially during the first 3 years after diagnosis, may impact patients more profoundly than direct costs and are important for inclusion in shared decision making.
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Affiliation(s)
- Daniel D Joyce
- Correspondence to: Daniel D. Joyce, MD, Department of Urology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA (e-mail: )
| | | | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ann S Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA
| | - Lisa E Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brock B O’Neil
- Department of Urology, University of Utah Health, Salt Lake City, UT, USA
| | - Sherrie H Kaplan
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Sheldon Greenfield
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA,Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Nyame YA, Cooperberg MR, Cumberbatch MG, Eggener SE, Etzioni R, Gomez SL, Haiman C, Huang F, Lee CT, Litwin MS, Lyratzopoulos G, Mohler JL, Murphy AB, Pettaway C, Powell IJ, Sasieni P, Schaeffer EM, Shariat SF, Gore JL. Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care. Eur Urol 2022; 82:341-351. [PMID: 35367082 DOI: 10.1016/j.eururo.2022.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Men of African ancestry have demonstrated markedly higher rates of prostate cancer mortality than men of other races and ethnicities around the world. In fact, the highest rates of prostate cancer mortality worldwide are found in the Caribbean and Sub-Saharan West Africa, and among men of African descent in the USA. Addressing this inequity in prostate cancer care and outcomes requires a focused research approach that creates durable solutions to address the structural, social, environmental, and health factors that create racial disparities in care and outcomes. OBJECTIVE To introduce a conceptual model for evaluating racial inequities in prostate cancer care to facilitate the development of translational research studies and interventions. EVIDENCE ACQUISITION A collaborative review of literature relevant to racial inequities in prostate cancer care and outcomes was performed. Existing literature was used to highlight various components of the conceptual model to inform future research and interventions toward equitable care and outcomes. EVIDENCE SYNTHESIS Racial inequities in prostate cancer outcomes are driven by a series of structural and social determinants of health that impact exposures, mediators, and outcomes. Social determinants of equity, such as laws/policies, economic systems, and structural racism, affect the inequitable access to environmental and neighborhood exposures, in addition to health care access. Although the incidence disparity remains problematic, various studies have demonstrated parity in outcomes when social and health factors, such as access to equitable care, are normalized. Few studies have tested interventions to reduce inequities in prostate cancer among Black men. CONCLUSIONS Worldwide, men of African ancestry demonstrate worse outcomes in prostate cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and health care risks. A conceptual model was presented that organizes the many factors that influence prostate cancer incidence and mortality. Within that framework, we must understand the current state of inequities in clinical prostate cancer practice, the optimal state of what equitable practice would be, and how achieving equity in prostate cancer care balances costs, benefits, and harms. More robust characterization of the sources of prostate cancer inequities should inform testing of ambitious and innovative interventions as we work toward equity in care and outcomes. PATIENT SUMMARY Men of African ancestry demonstrate the highest rates of prostate cancer mortality, which may be reduced through social interventions. We present a framework for formalizing the identification of the drivers of prostate cancer inequities to facilitate the development of interventions and trials to eradicate them.
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Affiliation(s)
- Yaw A Nyame
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Scott E Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Haiman
- Department of Preventive Medicine, Center for Genetic Epidemiology, University of Southern California, Los Angeles, CA, USA
| | - Franklin Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl T Lee
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Mark S Litwin
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes, Institute of Epidemiology & Health Care, University College London, London, UK
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Curtis Pettaway
- Department of Urology, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Isaac J Powell
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Peter Sasieni
- Cancer Research UK & King's College London Cancer Prevention Trials Unit, King's College London, London, UK
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - John L Gore
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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8
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Wallis CJD, Zhao Z, Huang LC, Penson DF, Koyama T, Kaplan SH, Greenfield S, Luckenbaugh AN, Klaassen Z, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Hoffman KE, Barocas DA. Association of Treatment Modality, Functional Outcomes, and Baseline Characteristics With Treatment-Related Regret Among Men With Localized Prostate Cancer. JAMA Oncol 2022; 8:50-59. [PMID: 34792527 PMCID: PMC8603232 DOI: 10.1001/jamaoncol.2021.5160] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Treatment-related regret is an integrative, patient-centered measure that accounts for morbidity, oncologic outcomes, and anxiety associated with prostate cancer diagnosis and treatment. OBJECTIVE To assess the association between treatment approach, functional outcomes, and patient expectations and treatment-related regret among patients with localized prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based, prospective cohort study used 5 Surveillance, Epidemiology, and End Results (SEER)-based registries in the Comparative Effectiveness Analysis of Surgery and Radiation cohort. Participants included men with clinically localized prostate cancer from January 1, 2011, to December 31, 2012. Data were analyzed from August 2, 2020, to March 1, 2021. EXPOSURES Prostate cancer treatments included surgery, radiotherapy, and active surveillance. MAIN OUTCOMES AND MEASURES Patient-reported treatment-related regret using validated metrics. Regression models were adjusted for demographic and clinicopathologic characteristics, treatment approach, and patient-reported functional outcomes. RESULTS Among the 2072 men included in the analysis (median age, 64 [IQR, 59-69] years), treatment-related regret at 5 years after diagnosis was reported in 183 patients (16%) undergoing surgery, 76 (11%) undergoing radiotherapy, and 20 (7%) undergoing active surveillance. Compared with active surveillance and adjusting for baseline differences, active treatment was associated with an increased likelihood of regret for those undergoing surgery (adjusted odds ratio [aOR], 2.40 [95% CI, 1.44-4.01]) but not radiotherapy (aOR, 1.53 [95% CI, 0.88-2.66]). When mediation by patient-reported functional outcomes was considered, treatment modality was not independently associated with regret. Sexual dysfunction, but not other patient-reported functional outcomes, was significantly associated with regret (aOR for change in sexual function from baseline, 0.65 [95% CI, 0.52-0.81]). Subjective patient-perceived treatment efficacy (aOR, 5.40 [95% CI, 2.15-13.56]) and adverse effects (aOR, 5.83 [95% CI, 3.97-8.58]), compared with patient expectations before treatment, were associated with treatment-related regret. Other patient characteristics at the time of treatment decision-making, including participatory decision-making tool scores (aOR, 0.80 [95% CI, 0.69-0.92]), social support (aOR, 0.78 [95% CI, 0.67-0.90]), and age (aOR, 0.78 [95% CI, 0.62-0.97]), were significantly associated with regret. Results were comparable when assessing regret at 3 years rather than 5 years. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that more than 1 in 10 patients with localized prostate cancer experience treatment-related regret. The rates of regret appear to differ between treatment approaches in a manner that is mediated by functional outcomes and patient expectations. Treatment preparedness that focuses on expectations and treatment toxicity and is delivered in the context of shared decision-making should be the subject of future research to examine whether it can reduce regret.
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Affiliation(s)
- Christopher J. D. Wallis
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada,Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Amy N. Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Franklin, Tennessee
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans
| | - Lisa E. Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City
| | - Brock B. O’Neil
- Department of Urology, University of Utah Health, Salt Lake City
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Center, Houston
| | - Daniel A. Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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9
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Affiliation(s)
- Randy A Jones
- University of Virginia School of Nursing, Charlottesville
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10
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Owens OL, Estrada RM, Johnson K, Cogdell M, Fried DB, Gansauer L, Kim S. 'I'm not a chance taker': A mixed methods exploration of factors affecting prostate cancer treatment decision-making. ETHNICITY & HEALTH 2021; 26:1143-1162. [PMID: 30987436 PMCID: PMC7184517 DOI: 10.1080/13557858.2019.1606165] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES African American prostate cancer survivors experience post-treatment decisional regret more often than European Americans, which can lead to negative long-term effects on quality of life. A prominent driver of health-related decision-making is emotion, yet little work has examined the impact emotions may have on decisional regret. The goal of this study was to explore experiences, perceptions, and emotions of prostate cancer survivors in relation to their diagnostic and treatment decision-making processes, prostate cancer treatment, and outcomes. Additionally, we sought to identify factors that might explain differences in prostate cancer outcomes between African and European Americans. DESIGN This mixed-methods study utilized a convergent parallel design, in which quantitative and qualitative data were collected simultaneously and then integrated to more robustly explain relationships between variables. Survivors were eligible for the study if they had been previously diagnosed with localized prostate cancer and were no more than six months post-treatment. The study was guided by the Risk as Feelings Model, which predicts the relationship between emotion and cognition in high-risk decision-making. RESULTS No men experienced decisional regret following treatment, even if they experienced side effects. While all men reported being surprised about their prostate cancer diagnosis, strong negative emotions were more common among men under 65. Family support and spirituality appeared to mitigate negative emotions. Perceived authenticity of provider communication was the most influential mediator in men's decision-making and positive perceptions of their outcomes. CONCLUSIONS To mitigate the impact emotional responses have on decision-making and post-treatment regret, providers should explore alternate therapies (e.g. counseling for men diagnosed with prostate cancer at a young age) and include family members in prostate cancer treatment discussions. Most importantly, providers should be aware of the importance of quality communication on men's cognitive and emotional processes and their perceptions of treatment outcomes.
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Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Robin M Estrada
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Kim Johnson
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Micheal Cogdell
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Daniel B Fried
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Lucy Gansauer
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Simon Kim
- Yale University Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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11
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Szproch AK, Maguire R. A systematic review of the factors associated with regret post-cancer treatment. J Psychosoc Oncol 2020; 40:1-25. [PMID: 33191874 DOI: 10.1080/07347332.2020.1844846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PROBLEM IDENTIFICATION Expanding on previous work in specific cancer populations, this review aimed to explore factors associated with decisional regret following treatment for a range of cancer types. LITERATURE SEARCH A systematic search of four databases identified 1747 studies, using search terms relating to cancer survivors and decisional regret. Following quality appraisal, correlates of regret were abstracted and analyzed using narrative synthesis. DATA EVALUATION/SYNTHESIS Seventy-two studies met the inclusion criteria. Factors associated with treatment regret were categorized as being either modifiable or less modifiable. Regret was associated with various sociodemographic factors, physical health, treatment type, an unsatisfactory decision-making process, poorer mental health and lack of social support. CONCLUSION Results highlight the complex nature of regret and illustrate how this can be experienced following a range of cancer treatments. As regret can be an obstacle to full-recovery from cancer, this review suggests some ways in which the emergence of regret may be mitigated.
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Affiliation(s)
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
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12
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Guan T, Guo P, Judge Santacroce S, Chen DG, Song L. Illness Uncertainty and Its Antecedents for Patients With Prostate Cancer and Their Partners. Oncol Nurs Forum 2020; 47:721-731. [PMID: 33063780 DOI: 10.1188/20.onf.721-731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Guided by Mishel's uncertainty in illness theory, patterns of change in uncertainty were explored over time for patients with prostate cancer and their partners. In addition, the relationships between uncertainty and its antecedents were examined, and the role effects (patient versus partner) on these relationships were assessed. SAMPLE & SETTING This study is a secondary analysis of the longitudinal data collected from a randomized clinical trial. METHODS & VARIABLES The current authors fitted multiple-level models that included time-invariant baseline variables (sociodemographics and cancer factors) and time-varying variables (uncertainty, symptoms, and social support) measured at baseline and at 4, 8, and 12 months thereafter. RESULTS No statistically significant patterns of change in uncertainty over time were detected. Partners reported greater uncertainty than patients. Higher uncertainty was associated with more general and prostate cancer-specific symptoms, recurrent and advanced prostate cancer, higher prostate-specific antigen level, and lower social support. More urinary symptoms were associated with greater uncertainty in patients than in partners. IMPLICATIONS FOR NURSING Uncertainty management can be tailored for and target symptom management and social support.
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Affiliation(s)
- Ting Guan
- University of North Carolina at Chapel Hill
| | - Peiran Guo
- University of North Carolina at Chapel Hill
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13
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Aarhus RT, Huang E. Study structure may compromise understanding of longitudinal decision regret stability: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:1507-1517. [PMID: 32248987 DOI: 10.1016/j.pec.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 02/13/2020] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To perform a systematic review of decision regret studies in cancer patients to determine if regret is longitudinally stable, and whether these study structures account for late-emerging treatment effects. METHODS Online databases including the George Mason Libraries, Global Health, Nursing and Allied Health, and PubMed were searched to identify decision regret studies with longitudinal components in patients with cancer. RESULTS A total of 845 unique citations were identified; 20 studies met inclusion criteria. Data was also collected on the time horizon for 90 studies; 47 % of studies evaluated regret at time points of one year or less, although this has increased significantly in prostate cancer citations since 2010. Regret was infrequent, affecting less than 20 % of patients, and often stable. Effect sizes in studies where decision regret changed over time were small to negligible. CONCLUSION Longitudinal effects can influence the expression of decision regret, yet many studies are not designed to collect long-term data; prostate cancer studies may be particularly disadvantaged. The degree of this influence in current studies is small, though this outcome must be interpreted with caution. PRACTICE IMPLICATIONS Providers should be aware of the risk of late-emerging regret and counsel patients appropriately.
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Affiliation(s)
- Robert T Aarhus
- Department of Systems Engineering and Operations Research, George Mason University, Fairfax, Virginia, USA.
| | - Edward Huang
- Department of Systems Engineering and Operations Research, George Mason University, Fairfax, Virginia, USA.
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14
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Joyce DD, Heslop DL, Umoh JI, Brown SD, Robles JA, Wallston KA, Moses KA. Examining the association of health literacy and numeracy with prostate-related knowledge and prostate cancer treatment regret. Urol Oncol 2020; 38:682.e11-682.e19. [PMID: 32448502 PMCID: PMC10129910 DOI: 10.1016/j.urolonc.2020.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Educational materials used in prostate cancer shared decision-making are often written above the health literacy levels of the patients that may benefit the most from such tools. Poor understanding the oncologic and functional outcomes of prostate cancer treatment may influence patient regret during this process. In this study, we assess the association between health literacy, numeracy, prostate-related knowledge and treatment regret in a diverse population. MATERIALS AND METHODS Patients obtaining care between June and August of 2016 at both community-based and academic tertiary care facilities were assessed for health literacy and numeracy using validated instruments. Prostate knowledge was tested in those patients without a history of prostate cancer using a 29-item questionnaire and patient-level predictors of knowledge were assessed. Prostate cancer treatment regret was assessed in those patients who had a history of prostate cancer. RESULTS A total of 90 patients were enrolled, 38 (42%) of whom had a history of prostate cancer. African American race (I = 0.039), financial strain (P < 0.001), and educational attainment (P < 0.001) were all associated with lower health literacy on multivariable analysis. Possessing a professional degree (P = 0.021) and higher health literacy (P = 0.001) were associated with greater prostate-related knowledge. Of those with a history of prostate cancer, 9 (24%) expressed treatment regret. Patients with regret were more likely to be African American (n = 6, 66.7% vs. 5, 17.2%, P = 0.004), not married (P = 0.016), and score lower on the literacy (1.0 vs. 8.0, P = 0.009) and numeracy (10.0 vs. 16.0, P = 0.016) scales. CONCLUSIONS We identified lower health literacy among African American men, and lower prostate-related knowledge in those with poor health literacy. To our knowledge, this is the first study to show an association between health literacy and prostate cancer treatment regret.
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15
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Adaptation and Initial Psychometric Evaluation of an Informed Prostate Cancer Screening Decision Self-Efficacy Scale for African-American Men. J Racial Ethn Health Disparities 2020; 7:746-759. [PMID: 31997285 DOI: 10.1007/s40615-020-00702-0] [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: 09/03/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether computer-based prostate cancer screening decision aids enhance decision self-efficacy for African-American men, culturally relevant and reliable measures are needed. However, limited psychometric evidence exists on the health-related decision self-efficacy of African-American men. This study describes the development and psychometric evaluation of the 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale among 354 African-American men. METHODS Exploratory factor analysis was conducted with maximum-likelihood estimation and polychoric correlations followed by Promax and Varimax rotations. RESULTS Exploratory factor analysis yielded a one-factor, 11-item model of the modified scale with excellent internal consistency reliability at 0.95 and factor loadings ranging from 0.70 to 0.90. Both parallel analysis and a scree plot confirmed the retention of one factor, and the standardized root mean square residual (0.06) indicated that the factor structure explained most of the correlations. CONCLUSIONS Findings suggest the one-factor, 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale has excellent psychometric properties and utility in reliably measuring health-related decision self-efficacy in African-American men. Future research is needed to confirm this factor structure among socio-demographically diverse African Americans.
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16
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Regret in Surgical Decision Making: A Systematic Review of Patient and Physician Perspectives. World J Surg 2018; 41:1454-1465. [PMID: 28243695 DOI: 10.1007/s00268-017-3895-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Regret is a powerful motivating factor in medical decision making among patients and surgeons. Regret can be particularly important for surgical decisions, which often carry significant risk and may have uncertain outcomes. We performed a systematic review of the literature focused on patient and physician regret in the surgical setting. METHODS A search of the English literature between 1986 and 2016 that examined patient and physician self-reported decisional regret was carried out using the MEDLINE/PubMed and Web of Science databases. Clinical studies performed in patients and physicians participating in elective surgical treatment were included. RESULTS Of 889 studies identified, 73 patient studies and 6 physician studies met inclusion criteria. Among the 73 patient studies, 57.5% examined patients with a cancer diagnosis, with breast (26.0%) and prostate (28.8%) cancers being most common. Interestingly, self-reported patient regret was relatively uncommon with an average prevalence across studies of 14.4%. Factors most often associated with regret included type of surgery, disease-specific quality of life, and shared decision making. Only 6 studies were identified that focused on physician regret; 2 pertained to surgical decision making. These studies primarily measured regret of omission and commission using hypothetical case scenarios and used the results to develop decision curve analysis tools. CONCLUSION Self-reported decisional regret was present in about 1 in 7 surgical patients. Factors associated with regret were both patient- and procedure related. While most studies focused on patient regret, little data exist on how physician regret affects shared decision making.
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17
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Hawley ST, Morris AM. Cultural challenges to engaging patients in shared decision making. PATIENT EDUCATION AND COUNSELING 2017; 100:18-24. [PMID: 27461943 PMCID: PMC5164843 DOI: 10.1016/j.pec.2016.07.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Engaging patients in their health care through shared decision-making is a priority embraced by several national and international groups. Missing from these initiatives is an understanding of the challenges involved in engaging patients from diverse backgrounds in shared decision-making. In this commentary, we summarize some of the challenges and pose points for consideration regarding how to move toward more culturally appropriate shared decision-making. DISCUSSION The past decade has seen repeated calls for health policies, research projects and interventions that more actively include patients in decision making. Yet research has shown that patients from different racial/ethnic and cultural backgrounds appraise their decision making process less positively than do white, U.S.-born patients who are the current demographic majority. CONCLUSION While preliminary conceptual frameworks have been proposed for considering the role of race/ethnicity and culture in healthcare utilization, we maintain that more foundational and empirical work is necessary. We offer recommendations for how to best involve patients early in treatment and how to maximize decision making in the way most meaningful to patients. Innovative and sustained efforts are needed to educate and train providers to communicate effectively in engaging patients in informed, shared decision-making and to provide culturally competent health care.
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Affiliation(s)
- Sarah T Hawley
- Professor of Medicine and Health Management and Policy, University of Michigan & Research Investigator, Ann Arbor VA Center for Clinical Management Research, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI 48109, United States.
| | - Arden M Morris
- Associate Professor of Surgery and Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
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18
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Leapman M, Jazayeri SB, Katsigeorgis M, Hobbs A, Samadi DB. Patient-perceived Causes of Prostate Cancer: Result of an Internet-based Survey. Urology 2017; 99:69-75. [DOI: 10.1016/j.urology.2016.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/31/2016] [Accepted: 09/03/2016] [Indexed: 11/15/2022]
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19
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Jazayeri SB, Sebrow D, Lavery H, Hobbs A, Levinson A, Samadi DB. Improvement of severe baseline lower urinary tract symptoms following robotic-assisted laparoscopic prostatectomy. Neurourol Urodyn 2016; 36:1382-1386. [DOI: 10.1002/nau.23118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/19/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | - Dov Sebrow
- Department of Urology; The Mount Sinai Medical Center; New York New York
| | - Hugh Lavery
- Department of Urology; The Mount Sinai Medical Center; New York New York
| | - Adele Hobbs
- Department of Urology; The Mount Sinai Medical Center; New York New York
| | - Adam Levinson
- Department of Urology; The Mount Sinai Medical Center; New York New York
| | - David B. Samadi
- Department of Urology; Lenox Hill Hospital; New York New York
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20
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Chan JL, Letourneau J, Salem W, Cil AP, Chan SW, Chen LM, Rosen MP. Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients. J Cancer Surviv 2016; 11:58-63. [PMID: 27480882 DOI: 10.1007/s11764-016-0563-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/24/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE Data have demonstrated an association between regret and lack of fertility counseling among patients undergoing treatment for non-gynecologic cancers. We sought to determine if fertility-related regret is reduced with pre-treatment counseling or fertility-sparing surgery (FSS) in patients with gynecologic cancers. METHODS A cross-sectional survey was administered to 593 reproductive-age survivors (18-40 years old at diagnosis) of localized cervix, ovarian, or endometrial cancers that were eligible for FSS. A validated decision regret score was used to evaluate regret in patients. RESULTS Four hundred seventy women completed the survey. Forty-six percent received pre-treatment counseling about treatment's effects on fertility. Having received counseling (adjusted ß-coefficient of -1.24, 95 % CI = -2.29 to -0.18, p = 0.02), satisfactory counseling (adjusted ß-coefficient of -2.71, 95 % CI = -3.86 to -1.57, p < 0.001), and FSS (adjusted ß-coefficient of -1.26, 95 % CI = -2.39 to -0.14, p = 0.03) were associated with lower regret post-treatment, after adjusting for age. Time since diagnosis, prior parity, socioeconomic status and cancer type were not associated with regret (p > 0.05). While 50 % of women reported desiring more children after diagnosis, desire for children after treatment was associated with increased regret (adjusted ß-coefficient of 3.97, 95 % CI = 2.92-5.02, p < 0.001). CONCLUSIONS Though less than half of study participants received counseling about the effect of cancer treatment on future fertility, both fertility counseling and FSS were associated with decreased regret in reproductive-aged women with gynecologic cancers. The desire for more children after treatment was associated with increased regret. IMPLICATIONS FOR CANCER SURVIVORS Inquiring about fertility desires and providing counseling regarding reproductive outcomes following cancer treatment should be implemented as part of the treatment process.
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Affiliation(s)
- Jessica L Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA. .,Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA.
| | - Joseph Letourneau
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Wael Salem
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA.,Department of Obstetrics and Gynecology, University of Southern California, 1240 North Mission Road, Los Angeles, CA, 90033, USA
| | - Aylin Pelin Cil
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA.,Istanbul Memorial Hospital ART and Reproductive Genetics Center, Piyale Pasa Bulvari, 34385, Okmeydani Sisli, Istanbul, Turkey
| | - Sai-Wing Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Lee-May Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
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Becerra Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and Predictors of Decision Regret about Health Care Decisions: A Systematic Review. Med Decis Making 2016; 36:777-90. [PMID: 26975351 DOI: 10.1177/0272989x16636113] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/06/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND People often face difficult decisions about their health and may later regret the choice that they made. However, little is known about the extent of decision regret in health care or its predictors. We systematically reviewed evidence about the extent of decision regret and its risk factors among individuals making health decisions. METHODS The data sources were Medline, Embase, and reverse citation searches in Google Scholar and Web of Science. Studies using the Decision Regret Scale (DRS) to measure decision regret among individuals making nonhypothetical health decisions were included. There were no restrictions on study design, setting, or language. We extracted characteristics of included studies, measures of central tendency for DRS scores (0 = no regret, 100 = high regret), and all risk factors from published analyses. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. A narrative synthesis was performed owing to the heterogeneity of studies. RESULTS The initial search yielded 372 unique titles, and 59 studies were included. The overall mean DRS score across studies was 16.5, and the median of the mean scores was 14.3 (standard deviation range = 2.2-34.5) (n = 44 studies). The risk factors most frequently reported to be associated with decision regret in multivariate analyses included higher decisional conflict, lower satisfaction with the decision, adverse physical health outcomes, and greater anxiety levels. CONCLUSIONS The extent of decision regret as assessed with the DRS in nonhypothetical health decisions was often low but reached high levels for some decisions. Several risk factors related to the decision-making process significantly predicted decision regret. Additional research into the psychometrics of the DRS and the relevance of scores for clinicians and patients would increase the validity of decision regret as a patient-reported outcome.
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Affiliation(s)
| | - Matthew Menear
- CHU de Québec Research Centre, Quebec City, Canada (MMBP, MM, FL),Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada (MM, FL)
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada (JB),School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada (JB)
| | - France Légaré
- CHU de Québec Research Centre, Quebec City, Canada (MMBP, MM, FL),Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada (MM, FL)
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Population Based Analysis of Incidence and Predictors of Open Conversion during Minimally Invasive Radical Prostatectomy. J Urol 2015; 193:826-31. [DOI: 10.1016/j.juro.2014.09.113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/17/2022]
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Christie DRH, Sharpley CF, Bitsika V. Why do patients regret their prostate cancer treatment? A systematic review of regret after treatment for localized prostate cancer. Psychooncology 2015; 24:1002-11. [DOI: 10.1002/pon.3776] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/15/2015] [Accepted: 01/27/2015] [Indexed: 11/09/2022]
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Song L, Toles MP, Bai J, Nielsen ME, Bailey DE, Sleath B, Mark B. Patient Participation in Communication about Treatment Decision-Making for Localized Prostate Cancer during Consultation Visits. Health (London) 2015; 7:1419-1429. [PMID: 34296220 PMCID: PMC8293682 DOI: 10.4236/health.2015.711156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives: To describe the communication behaviors of patients and physicians and patient participation in communication about treatment decision-making during consultation visits for localized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed); “low” (patient listening only); “moderate” (patient providing information or asking questions); and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories; 2) “low” in discussing survival/mortality; 3) “low and moderate” in discussing treatment options; 4) “none and low” in discussing treatment impacts; and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.
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Affiliation(s)
- Lixin Song
- School of Nursing, University of North Carolina (UNC), Chapel Hill, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina (UNC), Chapel Hill, USA
- Corresponding author.
| | - Mark P. Toles
- School of Nursing, University of North Carolina (UNC), Chapel Hill, USA
| | - Jinbing Bai
- School of Nursing, University of North Carolina (UNC), Chapel Hill, USA
| | - Matthew E. Nielsen
- Lineberger Comprehensive Cancer Center, University of North Carolina (UNC), Chapel Hill, USA
- Department of Urology, School of Medicine, University of North Carolina (UNC), Chapel Hill, USA
| | | | - Betsy Sleath
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
| | - Barbara Mark
- School of Nursing, University of North Carolina (UNC), Chapel Hill, USA
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The association between race and treatment regret among men with recurrent prostate cancer. Prostate Cancer Prostatic Dis 2014; 18:38-42. [PMID: 25348256 DOI: 10.1038/pcan.2014.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND To examine the impact of race on treatment regret among men with recurrent prostate cancer after surgery or radiation. METHODS The prospective Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry was used to study a cohort of 484 men with biochemically recurrent prostate cancer after radical prostatectomy, external beam radiation or brachytherapy. Multivariable logistic regression was used to model the association between race and treatment regret and to determine whether there was an interaction between race and sexual problems after treatment with regards to treatment regret. RESULTS Black men (N=78) were significantly more likely to have treatment regret when compared with non-black men (N=406; 21.8% versus 12.6%) on univariable analysis (odds ratio (OR) 1.94; 95% confidence interval 1.05-3.56; P=0.03). On multivariable analysis, black race trended towards but was no longer significantly associated with an increase in treatment regret (adjusted OR (AOR) 1.84 (0.95-3.58); P=0.071). There was an interaction between race and sexual problems after treatment (Pinteraction=0.02) such that among those without sexual problems, black men had more treatment regret than non-black men (26.7% versus 8.4%: AOR 4.68 (1.73-12.63); P=0.002), whereas among those with sexual problems, there was no difference in treatment regret between black and non-black men (18.8% versus 17.3%: AOR 1.04 (0.44-2.46); P=0.93). CONCLUSIONS Among men with recurrent prostate cancer after surgery or radiation, black men were nearly twice as likely to experience treatment regret. Treating physicians should ensure that patients are fully apprised of the pros and cons of all treatment options to reduce the risk of subsequent regret.
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Ziehr DR, Mahal BA, Aizer AA, Hyatt AS, Beard CJ, D Amico AV, Choueiri TK, Elfiky A, Lathan CS, Martin NE, Sweeney CJ, Trinh QD, Nguyen PL. Income inequality and treatment of African American men with high-risk prostate cancer. Urol Oncol 2014; 33:18.e7-18.e13. [PMID: 25306287 DOI: 10.1016/j.urolonc.2014.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/16/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Definitive treatment of high-risk prostate cancer with radical prostatectomy or radiation improves survival. We assessed whether racial disparities in the receipt of definitive therapy for prostate cancer vary by regional income. PATIENTS AND METHODS A cohort of 102,486 men (17,594 African American [AA] and 84,892 non-Hispanic white) with localized high-risk prostate cancer (prostate-specific antigen >20 ng/ml or Gleason ≥ 8 or stage ≥ cT2c) diagnosed from 2004 to 2010 was identified in the Surveillance, Epidemiology, and End Results database. Income was measured at the census-tract-level. We used multivariable logistic regression to assess patient and cancer characteristics associated with the receipt of definitive therapy for prostate cancer. Multivariable Fine and Gray competing risks analysis was used to evaluate factors associated with prostate cancer death. RESULTS Overall, AA men were less likely to receive definitive therapy than white men (adjusted odds ratio [AOR] = 0.51; 95% CI: 0.49-0.54; P<0.001), and there was a significant race/income interaction (Pinteraction = 0.016) such that there was a larger racial treatment disparity in the bottom income quintile (AOR = 0.49; 95% CI: 0.45-0.55; P<0.001) than in the top income quintile (AOR = 0.60; 95% CI: 0.51-0.71; P<0.001). After a median follow-up of 35 months, AA men in the bottom income quintile suffered the greatest prostate cancer mortality (adjusted hazard ratio = 1.47; 95% CI: 1.17-1.84; P = 0.001), compared with white men in the top income quintile. CONCLUSIONS Racial disparities in the receipt of definitive therapy for high-risk prostate cancer are greatest in low-income communities, suggesting that interventions to reduce racial disparities should target low-income populations first.
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Affiliation(s)
| | | | | | - Andrew S Hyatt
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Clair J Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Anthony V D Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Aymen Elfiky
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Christopher S Lathan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Christopher J Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
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