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Keywords:

  • decision-making;
  • localized prostate cancer;
  • subjective-affective factors;
  • cancer aggressiveness;
  • age

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. FUNDING SUPPORT
  9. REFERENCES

BACKGROUND:

The current study examined how patients' sociodemographic, cancer-related, and subjective affective factors impacted their role in treatment decision-making.

METHODS:

The patient sample (N = 788) was taken from a prospective follow-up study of a population-based cohort. Participants included 343 African American and 445 Caucasian-American patients with clinically localized prostate cancer. Multinomial logistic regression was used to investigate relations between the explanatory variables and the nominal 3-level decision-making variable: patient-only, patient-physician shared, and physician-only.

RESULTS:

Approximately 41% of patients reported patient-only decision-making, 45% reported shared decision-making, and 13% reported physician-only decision-making. The odds of patient-only over physician-only decision-making were greater for younger men (vs those aged ≥ 65 years) (odds ratio [OR], 1.68; 95% confidence interval [95% CI], 1.03-2.74), and were less for men with high (vs low) cancer aggressiveness (OR,0.29; 95% CI, 0.15-0.55). The odds of shared over physician-only decision-making were less for men with high (vs low) cancer aggressiveness (OR, 0.40; 95% CI, 0.22-0.73). Greater odds of patient-only and shared decision-making also were found to be associated with greater concerns about the physical impact of treatment and having enough time for decision-making and lower scores of receiving advice from others.

CONCLUSIONS:

The findings of the current study indicate that, to facilitate a more patient-oriented decision-making process regarding treatment in those with clinically localized prostate cancer, clinicians need to tailor their interventions according to patient age and cancer aggressiveness, help reduce patient concerns and misconceptions regarding the physical impact of treatments, allow sufficient time for patients to consider treatment options, and assist patients in balancing advice and information received from different sources. Cancer 2013. © 2012 American Cancer Society.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. FUNDING SUPPORT
  9. REFERENCES

The treatment decision-making task of weighing the tradeoffs between harm and benefit presents a salient challenge for men with clinically localized prostate cancer.1 To the best of our knowledge, no consensus exists among health professionals regarding which treatment is the best option. Each treatment has potential side effects (eg, impotence and incontinence) that often cause psychological (eg, uncertainty and anxiety)2-6 and social (eg, family relationships) distress.6-8 Men with clinically localized prostate cancer often report high levels of decision-related distress both at the time of diagnosis and after the completion of treatment.9-12 Up to 25% of long-term survivors experience misgivings or regrets about their treatment decision years after the initial treatment;13, 14 regrets are more prevalent among men who assume a passive role during decision-making.8 Thus, efforts to mitigate these negative outcomes require an understanding of potentially modifiable factors in the decision-making process for the treatment of prostate cancer.

The decision-making framework in medical care is comprised of 3 categories: physician-only (medical paternalism), patient-only (patient autonomy), and patient-physician collaboration (shared) decision-making.15, 16 Medical paternalism endorses a physician's authority and the belief that the physician knows more than the patient about what is good for the patient.17 However, in the care of patients with prostate cancer, the concordance with regard to information needs and decision control between physician perception and patient preference is reported to be as low as approximately 40%.18 Physicians who are charged with making decisions on behalf of patients are often poor judges of a patient's values, quality of life (QoL), and life expectancy.19 In contrast, the complexity of cancer diagnosis and risk stratification, and the multiple treatment options available, may make patient autonomy challenging; some patients may not want the responsibility of deciding among treatments.20 Between these 2 extremes, shared decision-making is regarded as a means of ensuring that health care decisions combine health professionals' knowledge and expertise regarding care options and outcomes with each individual patient's personal experiences, values, preferences, and life priorities.21 Shared decision-making and higher levels of patient involvement result in a better quality of care and increased satisfaction for both patients and medical staff.22

However, to our knowledge, little is known concerning the factors affecting who makes treatment decisions for patients with clinically localized prostate cancer. Studies have suggested that factors such as patient demographics and cancer-related factors such as educational level, marital status, the opinions of others, the recency of the diagnosis, cancer stage, and patient perception of cancer aggressiveness affect their preference for involvement in treatment decision-making before treatments are delivered.9, 12, 23 However, the concordance rate between a patient's preferred and actual role in decision-making varies considerably across studies and cancer types.24-26 Therefore, research is needed to examine whether these factors affect the actual treatment decision-making of patients with prostate cancer. In addition, research is also needed to validate the evidence that has been established in patients with chronic illnesses with regard to the impact of patients' subjective-affective experiences (eg, health care providers' attitudes and demeanors toward the patient and a patient's perception of communication about health problems and treatments as well as feelings of not being given appropriate information, not being listened to, and not being respected as an individual) on their role in decision-making.27, 28

In this population-based study, we hypothesized that a series of sociodemographic, cancer-related, and subjective-affective factors significantly impacted the roles of patients and physicians in treatment decision-making for patients with clinically localized prostate cancer. A broad range of factors allowed this study to attend to the contextual background of decision-making and therefore helped identify modifiable factors that can be targeted for intervention to facilitate a patient-oriented treatment decision-making process.

MATERIALS AND METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. FUNDING SUPPORT
  9. REFERENCES

This study included 343 African American and 445 Caucasian-American/white patients with clinically localized prostate cancer (T1 and T2 disease), drawing from the first follow-up of the Health Access and Prostate Cancer Treatment in North Carolina (HCaP-NC) study. The HCaP-NC study is a prospective follow-up study of the population-based cohort from the North Carolina-Louisiana Prostate Cancer Project (PCaP). The PCaP explored racial differences in prostate cancer aggressiveness through a comprehensive evaluation of individual, social, and tumor-level factors; 2216 patients from North Carolina and Louisiana aged 40 years to 79 years with newly diagnosed prostate cancer completed the study interview in English. These participants did not live in an institution (nursing home); were cognitively intact or not in a severely debilitated physical state; were not under the influence of alcohol, severely medicated, or apparently psychotic at the time of the interview; and self-identified as African American/black or Caucasian-American. The HCaP-NC study conducted long-term follow-up of PCaP participants from North Carolina. Using annual telephone interviews and a review of medical records, the study examined whether racial differences in health care access and availability contributed to racial differences in the quality of prostate cancer treatment received and patient QoL. The detailed sampling procedure and study methods of PCaP have been described elsewhere.29

The outcome variable “decision-maker” was obtained from the participants' response to the question “Who was mostly responsible for deciding what to do about prostate cancer when you were first diagnosed?” Responses were categorized into 3 groups: patient-only, patient-physician shared (shared), and physician-only decision-making.

Sociodemographic factors (including age, education, and marital status) and cancer characteristics (including disease classification [ie, T1 and T2] and types of treatment) were obtained from patient medical records or self-report. Cancer aggressiveness, derived based on clinical grade, clinical stage, and serum prostate-specific antigen (PSA) level at the time of diagnosis, was categorized into 3 levels: high aggressiveness (ie, Gleason score ≥ 8 or PSA > 20 ng/mL or Gleason score of 7 with cT3–cT4 disease), low aggressiveness (ie, Gleason score < 7, cT1–cT2 disease, and PSA < 10 ng/mL), or intermediate aggressiveness (all other cases).29

The subjective-affective factors that may impact patient involvement in treatment decision-making, selected based on the above-mentioned literature review, included: 1) concerns about treatment (physical [6-item], financial [7-item], and relational [2-item] impacts); 2) concerns about whether the treatment(s) can control/cure cancer (cancer control) (3-item); 3) patient satisfaction with the decision-making process (4 single-item scales); 4) advice from others (5-item); 5) patient-health care provider communication (5-item); and 6) the health care provider's contextual knowledge of the patient (4-item). The reliability of the 5-point Likert scales in the current study is shown in Table 1. Higher scores indicated more concerns, greater satisfaction, more advice from others, more patient-provider communication, and more contextual knowledge about the patient.

Table 1. Participant Characteristics
CharacteristicsNo. (%) (N = 788)
Age, y 
 <65483 (63)
 ≥65280 (37)
Marital status 
 Married620 (79)
 Not married168 (21)
Race 
 African American343 (43)
 Caucasian-American445 (57)
Education 
 ≤High school342 (43)
 ≥Some college446 (57)
T classification 
 T1490 (63)
 T2293 (37)
Cancer aggressiveness 
 Low423 (54)
 Intermediate252 (32)
 High112 (14)
Decision-maker 
 Patient only323 (41)
 Patient-physician shared355 (46)
 Physician only103 (13)
Type of treatmenta 
 Prostatectomy510 (65)
 Radiation239 (30)
 Androgen deprivation therapy115 (15)
 Active surveillance63 (8)
 Other treatmentsb99 (13)
 Cronbach αMean (SD)
  • Abbreviation: SD, standard deviation.

  • a

    The total is >100% because some patients used >1 type of treatment.

  • b

    Other treatments include chemotherapy, cryotherapy, clinical trial, etc.

Concerns about treatment  
 1) Physical impact0.8825.06 (7.32)
 2) Financial impact0.8620.13 (8.10)
 3) Relationship impact0.8414.35 (1.96)
 4) Cancer control0.896.69 (2.62)
Satisfaction about decision-making process
 1) Having needed information4.17 (1.06)
 2) Physicians discussing all treatment side effects4.09 (1.12)
 3) Knowing the right questions to ask4.40 (0.87)
 4) Having enough time4.34 (1.01)
Advice from others0.7318.09 (4.53)
Patient-provider communication0.9422.52 (3.58)
Contextual knowledge about the patient0.9116.25 (3.55)

Statistical Analysis

Multinomial logistic regression (ie, model based on generalized logits) was performed using SAS statistical software (version 9.2; SAS Institute Inc, Cary, NC) to test the research hypothesis. Unadjusted and adjusted models were fitted to examine the relations between the decision-maker and 2 sets of predictors: 1) sociodemographic and cancer characteristic factors (ie, age [< 65 years vs ≥ 65 years], race [white or African American], marital status [married vs not married], education [≤ high school diploma vs ≥ some college], and cancer aggressiveness [low, intermediate, or high]); and 2) subjective-affective factors. The fully adjusted model was fitted to simultaneously examine how both the sociodemographic and cancer characteristics and subjective-affective factors influenced prostate cancer treatment decision-making. Finally, backward elimination was used to obtain the reduced model to identify which of the a priori factors were of primary importance.

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. FUNDING SUPPORT
  9. REFERENCES

The majority of the 788 study participants were aged < 65 years, married, and had cancer of low to intermediate aggressiveness (Table 1). Slightly greater than one-half of the participants were white, with some having college or higher levels of education. Approximately 67% of the participants had undergone radical prostatectomy. The percentages of patient-only, patient-physician shared, and physician-only decision-making were approximately 41%, 45%, and 13%, respectively.

In the models that examined the relations between decision-making and sociodemographic and cancer characteristics (Table 2), only age and high cancer aggressiveness were found to be significant in the adjusted model. Comparing patient-only with physician-only decision-making, the odds were 2.12 times greater (95% CI, 1.31-3.41) for younger men compared with those aged ≥ 65 years, but were 0.34 times less (95% CI, 0.19-0.64) for patients with high cancer aggressiveness compared with those with low cancer aggressiveness. Comparing patient-physician shared with physician-only decision-making, the odds were 0.45 times less (95% CI, 0.25-0.81) for patients with high cancer aggressiveness compared with those with low cancer aggressiveness.

Table 2. Impact of Personal and Cancer Characteristics on Treatment Decision-Making
VariableUnadjusted Model, OR (95% CI)Adjusted Model (Including All Variables), OR (95% CI)
Patient-Only vs Physician-OnlyShared vs Physician-OnlyPatient-Only vs Physician-OnlyShared vs Physician-Only
  1. Abbreviations: 95% CI, 95% confidence interval; OR, odds ratio.

Age, y    
 ≥65 (reference)    
 <652.24 (1.43-3.52)1.43 (0.92-2.22)2.12 (1.31-3.41)1.36 (0.855-2.16)
Race    
 African American (reference)    
 Caucasian-American/white1.25 (0.80-1.95)1.17 (0.75-1.82)1.14 (0.69-1.90)1.06 (0.65-1.73)
Marital status    
 Married (reference)    
 Not married1.46 (0.89-2.41)1.77 (1.07-2.92)1.19 (0.70-2.03)1.51 (0.89-2.56)
Education    
 ≤High school (reference)    
 ≥Some college0.51 (0.33-0.80)0.69 (0.44-1.07)0.63 (0.39-1.02)0.82 (0.51-1.31)
Cancer aggressiveness    
 Low (reference)    
 Intermediate0.76 (0.45-1.29)0.98 (0.58-1.63)0.78 (0.46-1.33)0.99 (0.59-1.66)
 High0.29 (0.16-0.53)0.40 (0.23-0.71)0.34 (0.19-0.64)0.45 (0.25-0.81)

In the models that examined the relations between decision-making and subjective-affective factors (Table 3), only the concerns of physical impact and having enough time for decision-making were found to be significant in the adjusted model. Comparing patient-only with physician-only decision-making, the odds were 1.08 greater for each 1-unit increase in the concerns of physical impact (95% CI, 1.04-1.12) and were 1.48 times greater for each 1-unit increase in the score for having enough time for decision-making (95% CI, 1.07-2.05).

Table 3. Impact of Subjective-Affective Factors on Treatment Decision-Making
VariableUnadjusted Model OR (95% CI)Adjusted Model (Including All Variables) OR (95% CI)
Patient-Only vs Physician-OnlyShared vs Physician-OnlyPatient-Only vs Physician-OnlyShared vs Physician-Only
  1. Abbreviations: 95% CI, 95% confidence interval; OR, odds ratio.

Concerns about treatment    
 1) Physical impact1.06 (1.03-1.09)1.05 (1.02-1.08)1.08 (1.04-1.12)1.04 (1.00-1.08)
 2) Financial impact0.99 (0.96-1.02)1.02 (0.99-1.04)0.97 (0.94-1.01)0.99 (0.96-1.03)
 3) Relationship impact1.04 (0.95-1.13)1.09 (1.00-1.18)1.02 (0.91-1.14)1.04 (0.93-1.16)
 4) Cancer control1.10 (1.01-1.22)1.09 (1.00-1.20)1.07 (0.95-1.20)1.03 (0.92-1.16)
Satisfaction about decision-making process    
 1) Having needed information1.07 (0.88-1.30)1.22 (1.00-1.49)0.97 (0.72-1.31)1.04 (0.77-1.40)
 2) Physicians discussing all treatment side effects1.12 (0.93-1.34)1.32 (1.09-1.59)0.95 (0.70-1.28)1.07 (0.80-1.45)
 3) Knowing the right questions to ask1.10 (0.92-1.32)1.17 (0.98-1.41)0.99 (0.77-1.27)0.95 (0.74-1.22)
 4) Having enough time1.41 (1.13-1.77)1.51 (1.21-1.90)1.48 (1.07-2.05)1.35 (0.98-1.87)
Advice from others0.99 (0.94-1.04)1.03 (0.98-1.09)0.95 (0.89-1.02)0.99 (0.93-1.05)
Patient-provider communication1.03 (0.97-1.09)1.07 (1.01-1.13)1.03 (0.95-1.13)1.05 (0.96-1.15)
Contextual knowledge about the patient1.01 (0.94-1.09)1.05 (0.97-1.13)0.94 (0.85-1.03)0.95 (0.87-1.05)

In the fully adjusted model that simultaneously examined the relations between decision-making and sociodemographic, cancer-related, and subjective-affective factors (Table 4), only the effects of age, high cancer aggressiveness, concerns of physical impact, and having enough time for decision-making remained significant. In the reduced model obtained from the fully adjusted model using backward elimination, advice from others as well as high cancer aggressiveness, concerns of physical impact, and having enough time for decision-making were found to be significantly associated with decision-making (Fig. 1). Specifically, comparing patient-only with physician-only decision-making, the odds were 1.68 times greater (95% CI, 1.03-2.74) for younger men than for men aged ≥ 65 years, and were 0.29 times less (95% CI, 0.15-0.55) for men with high cancer aggressiveness compared with those with low cancer aggressiveness. Comparing patient-physician shared with physician-only decision-making, the odds were 0.40 times less (95% CI, 0.22-0.73) for men with high cancer aggressiveness than for those with low cancer aggressiveness. Compared with the odds for physician-only decision-making, with a 1-unit increase in concerns regarding physical impact, the odds were 1.06 times greater (95% CI, 1.03-1.10) for patient-only and approximately 1.04 times greater (95% CI, 1.01-1.08) for patient-physician shared decision-making; similarly, with a 1-unit increase in the score of having enough time for decision-making, the odds were 1.33 times greater (95% CI, 1.04-1.70) for patient-only and 1.38 times greater (95% CI, 1.09-1.75) for patient-physician shared decision-making than for physician-only decision-making; with a 1-unit increase in the score concerning advice received from others, the odds were 0.94 times less (95% CI, 0.89-0.99) for patient-only than for physician-only decision-making.

Table 4. Impact of Personal and Cancer Characteristics and Subjective-Affective Factors on Treatment Decision-Making
VariableFully Adjusted Model, OR (95% CI)Reduced Model, OR (95% CI)
Patient-Only vs Physician-OnlyShared vs Physician-OnlyPatient-Only vs Physician-OnlyShared vs Physician-Only
  1. Abbreviations: 95% CI, 95% confidence interval; OR, odds ratio.

Age, y    
 ≥65 (reference)    
 <652.12 (1.31-3.41)1.36 (0.85-2.16)1.68 (1.03-2.74)1.13 (0.70-1.81)
Race    
 African American (reference)    
 White1.14 (0.69-1.90)1.06 (0.65-1.73)  
Marital status    
 Not married (reference)    
 Married1.19 (0.70-2.03)1.51 (0.89-2.57)  
Education    
 ≤High school (reference)    
 ≥Some college0.63 (0.39-1.02)0.82 (0.51-1.31)  
Cancer aggressiveness    
 Low (reference)    
 Intermediate0.78 (0.46-1.33)0.99 (0.59-1.66)0.77 (0.45-1.34)1.01 (0.59-1.73)
 High0.34 (0.19-0.64)0.45 (0.25-0.81)0.29 (0.15-0.55)0.40 (0.22-0.73)
Concerns about treatment    
 1) Physical impact1.08 (1.04-1.12)1.04 (1.01-1.08)1.06 (1.03-1.10)1.04 (1.01-1.08)
 2) Financial impact0.97 (0.94-1.01)0.99 (0.96-1.03)  
 3) Relationship impact1.02 (0.91-1.14)1.04 (0.93-1.16)  
 4) Cancer control1.07 (0.95-1.20)1.03 (0.92-1.16)  
Satisfaction about decision-making process    
 1) Having needed information0.97 (0.72-1.31)1.04 (0.77-1.40)  
 2) Physicians discussing all treatment side effects0.95 (0.70-1.28)1.08 (0.79-1.45)  
 3) Knowing the right questions to ask0.99 (0.77-1.27)0.95 (0.74-1.22)  
 4) Having enough time1.48 (1.07-2.06)1.35 (0.98-1.87)1.33 (1.04-1.70)1.38 (1.09-1.75)
Advice from others0.95 (0.89-1.02)0.98 (0.92-1.05)0.94 (0.89-0.99)0.99 (0.94-1.05)
Patient-provider communication1.03 (0.95-1.13)1.05 (0.96-1.15)  
Contextual knowledge about the patient0.94 (0.85-1.03)0.95 (0.87-1.05)  
thumbnail image

Figure 1. Factors affecting decision-making regarding treatment of patients with clinically localized prostate cancer are shown. Int indicates intermediate cancer aggressiveness.

Download figure to PowerPoint

DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. FUNDING SUPPORT
  9. REFERENCES

In the United States, approximately 82% of patients have clinically localized prostate cancer at the time of diagnosis.30 Given the many alternatives for the treatment of clinically localized prostate cancer, the preference-sensitive nature of decision-making, and the potential for regret in this setting, decision-making roles between a patient and his physician(s) are of particular interest. In this racially diverse population-based study of men with clinically localized prostate cancer, patients endorsed a spectrum of treatment decision-making roles, similar to the findings of previous studies.20, 31, 32 Patient-physician shared decision-making was most common (45%), followed by patient-only (41%) and physician-only (13%).

Age, cancer aggressiveness, concerns about the physical impact of treatment, having enough time for decision-making, and receiving advice from others were found to be significantly associated with treatment decision-making. Compared with patients aged ≥ 65 years, younger men were more likely to engage in patient-only versus physician-only decision-making, a finding similar to that of previous studies.33, 34 Younger men may be more likely to seek information from different sources,34 including consultation from ≥ 3 physicians.35 These activities may better equip patients to make decisions on their own and/or to communicate with physicians regarding their needs and treatment preferences. The findings of the current study confirm that clinicians need to engage different strategies to facilitate treatment decision-making for prostate cancer patients of different ages.

Among cancer-related factors, compared with those with low cancer aggressiveness, patients with high cancer aggressiveness were more likely to endorse physician-only decision-making. The perceptions of invasiveness of the different treatment options for patients with clinically localized prostate cancer have been suggested to affect the type of treatment men choose.11, 12 The findings of the current study suggest that aggressive disease may not be a situation in which more patient participation is desirable. When faced with more aggressive disease, patients may not be as comfortable with their own decision-making ability, transferring greater importance to the decisions of the “experts,” (ie, the physician). Conversely, the diagnosis of a more aggressive cancer often results in stronger and more definitive treatment recommendations, whereas the lack of consensus data for cancer of low aggressiveness may cause physicians to place much more importance on patient preferences.

Among subjective-affective factors, more concerns regarding the physical impact of treatment were associated with increased probabilities of patient-only and patient-physician shared decision-making. How treatment may impact different aspects of QoL through possible side effects is one of the most important concerns for many patients; patients usually weigh the risks of potential physical impact and benefits when making treatment decisions.36 While previous small cohort studies indicated that consideration of treatment side effects is a major motivation when patients with clinically localized prostate cancer choose a treatment,37, 38 the current population-based study confirmed the effects of concerns of physical impact on men's active role in decision-making.

A clinically relevant finding was that patients' feelings of having enough time to make a decision is positively associated with greater probabilities of patient-only and patient-physician shared decision-making. The results of our post hoc analysis indicated that patients who took longer to decide on treatment were more likely to consider themselves to be involved in the decision-making process (data not shown). Among African American patients with cancer, a lack of sufficient time and feelings of being pressured by physicians were identified as one of the major reasons that patients surrendered their decision-making power to physicians.39 Having sufficient time allows patients to gather more detailed information from their own physician(s) and from other sources, including obtaining a second opinion from other providers. These processes contribute to positive experiences that in turn may give patients a sense of control and the feeling of active involvement in decision-making.

Surprisingly, more advice from others was associated with greater probabilities of physician-only decision-making and lower probabilities of patient-only decision-making. During cancer diagnosis and treatment, patients may not obtain all the needed information from their physicians and specialists.40 Talking with other health care providers, family members, friends, and cancer survivors would help to meet their needs during this stressful time.39, 40 Recommendations and advice from others have been identified by some patients with clinically localized prostate cancer as the most important factor influencing their decision-making.11 Advice from others also has been linked to patients' perceptions of greater social support and increased emotional expression after decision-making.41 Messages and communication that provide tangible assistance and reassurance and medical information in a language that patients understand were associated with the patient's treatment decision and decision-making process.42 It is possible that patients who have received more treatment-related advice from others believe that their treatment decision has been influenced more by others, especially by their physician(s), but less by themselves than what actually has happened.

The limitations of the current study warrant further exploration. First, the data were obtained approximately 3 years after patients completed treatment for clinically localized prostate cancer. Recollections and perceptions of a cancer treatment experience are sometimes adjusted and reappraised with the passage of time. Future research needs to be performed among patients with newly diagnosed prostate cancer to strengthen the empirical evidence concerning how patients' sociodemographic, cancer-related, and subjective-affective factors influence their treatment decision-making. Nonetheless, the findings of the current study corroborate the evidence from previous research, including a recent study of patients with newly diagnosed lung and colorectal cancer,20 and further our understanding of decision-making at various phases during a patient's illness. Second, the psychometric properties of some of the measurements were not established previously (ie, concerns about the physical, financial, and relationship impact; cancer control for clinically localized prostate cancer; or advice from others). However, the Cronbach alphas for these instruments (Table 1) demonstrated that they have satisfactory reliability for use in this study population. Finally, the cohort in the current study was younger than the average age of patients at the time of prostate cancer diagnosis and received surgery as their primary treatment more frequently than is usual in the United States; thus, our results may not apply to older patients or to patient populations in whom radiotherapy is more commonly used for the treatment of prostate cancer.

The question of who makes the decision regarding the treatment of patients with clinically localized prostate cancer is a complex one that is subject to a range of changing internal and external influences. The findings of the current study provide empirical evidence that the patient's sociodemographic and cancer characteristics, thoughts, and feelings about the decision-making process and interactions with others all affect his role in decision-making. Thus, patients' subjective-affective factors need to be taken into consideration when exploring issues and interventions related to prostate cancer treatment decision-making. To facilitate the decision-making process, clinicians may need to tailor interventions according to a patient's age and cancer aggressiveness, develop strategies that help to reduce concerns and misconceptions concerning the physical impact of treatments, allow sufficient time for patients to consider treatment options before making a decision, and help patients balance the advice and information received from different sources.

Acknowledgements

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. FUNDING SUPPORT
  9. REFERENCES

We thank the staff, advisory committees, and research subjects participating in the North Carolina-Louisiana Prostate Cancer Project (PCaP) and the Health Access and Prostate Cancer Treatment in North Carolina (HCaP-NC) study for their important contributions.

FUNDING SUPPORT

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. FUNDING SUPPORT
  9. REFERENCES

The North Carolina-Louisiana Prostate Cancer Project (PCaP) is supported by the Department of Defense contract DAMD 17-03-2-0052. The Health Care Access and Prostate Cancer Treatment in North Carolina (HCaP-NC) study is supported by American Cancer Society award RSGT-08-008-01-CPHPS.

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. FUNDING SUPPORT
  9. REFERENCES