Factors That Predict Treatment Choice and Satisfaction with the Decision in Men with Localized Prostate Cancer

doi:10.3816/CGC.2006.n.040

Clinical Genitourinary Cancer

Volume 5, Issue 3, December 2006, Pages 219-226

https://doi.org/10.3816/CGC.2006.n.040 Get rights and content

Abstract

Purpose: Men diagnosed with localized prostate cancer (LPC) often have the opportunity to participate in the treatment choice. The purpose of this study was to evaluate relationships between influential factors on treatment choice and the decision-related outcomes of decisional conflict and satisfaction. Patients and Methods: This report presents data from 260 men diagnosed with LPC who were identified by their clinicians as having a choice of treatments. Men completed questionnaires at home within 2 weeks of the informational clinic visit with the clinician, but before treatment. The respondent sample had a mean age of 63.2 years (standard deviation, 8.1 years); the majority were married/partnered (82.7%), working (51.5%), white (93.8%), and educated at the collegiate level (83.8%). Personal factors (information, influential people, and outcomes), treatment choice, and decisional conflict and satisfaction with the decision (SWD) were queried. Relationships between all variables and the outcomes, SWD, and treatment choice were explored using exhaustive χ² automatic interaction detector. Results: The strongest predictor partition variable for SWD was the subscale “factors contributing to uncertainty” (adjusted P < 0.0001) followed by the Trait Anxiety score (adjusted P = 0.0388). The strongest predictive partition for the actual treatment choice was age group (adjusted P < 0.0001), followed by interacting marital status (adjusted P = 0.0003), influence of the urologist (adjusted P = 0.0008), and use of the Internet (adjusted P = 0.0479). Men with LPC were more satisfied with their treatment choice when they reported fewer uncertainty factors; these are factors mainly relevant to information needed to understand the pros and cons and to make a decision. Consistent with this finding for treatment choice is the use of the Internet, though this factor interacted with age, the influence of their surgeon, and marital status. Conclusion: This study suggests that personally meaningful information communicated between patients and clinicians is paramount.

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Racial/ethnicity differences in endorsing influential factors for prostate cancer treatment choice: An analysis of data from the personal patient profile-prostate (P3P) I and II trials
2020, Urologic Oncology: Seminars and Original Investigations
Citation Excerpt :
Particpants were categoried based on race/ethnicity into H, NHB and NHW groups. The Personal Profile questionnaire was originally developed based on a qualitative study uncovering personal factors that influenced men's decisions for prostate cancer treatment, [17] and was subsequently implemented and assessed in a quantitative study of 260 men in which face validity and test-retest reliability were established [20]. The questionnaire groups influential factors (IFs) into 3 subcategories: influential people (spouse/partner, family member, coworker, friend, and celebrity), influential outcomes (bladder, bowel, sexual function, and expected survival), and personal characteristics (confidence in the doctor, age, work, religion, and recreational activities).
Rates and choice of treatment for localized prostate cancer vary according to race/ethnicity in American men. We hypothesized that there were group differences in influential values and preferences related to treatment decisions.
We analyzed samples from 2 multicenter, randomized trials of the Patient Profile-Prostate (P3P) I and II decision aid, first comparing the groups on other demographic and decisional variables using Chi-square tests. Stratified (P3P I vs. II) logistic regression was then used to assess the univariate association between race/ethnicity and endorsement of moderate-or-strong influence of 14 lifestyle factors, current or future symptoms, or important others on the decision. A multivariable stratified logistic regression with backward variable selection was used to further estimate the association between influential factors and race/ethnicity.
There were 494 and 392 participants in P3P I and P3P II, respectively, with 40 Hispanic, 168 non-Hispanic black, 637 non-Hispanic white, 19 others and 6 missing. Age (P = 0.0001), education (P < 0.0001), marital status (P < 0.0001), income (P < 0.0001), Internet use for information (P < 0.0001) and decisional control preference were significantly different across racial/ethnic groups. In adjusted analyses, we saw racial/ethnic differences in the decisional influence of age (Non-Hispanic Black (NHB) vs. Non-Hispanic White (NHW) OR: 0.56 95%CI 0.38–0.85 P = 0.002), religion/spirituality (NHB vs. NHW OR: 3.2095%CI1.95–5.26, P < 0.0001), future bladder function (NHB vs. NHW OR: 0.5795%CI 0.35–0.90, P = 0.04), future ability to engage in recreation (NHB vs. NHW OR: 0.5495%CI 0.34–0.86, P = 0.02), and a story of a famous person with prostate cancer (NHB vs. NHW OR: 2,11 95%CI 1.30–3.43, P = 0.007). No interactions were found.
Our results suggest racial/ethnic differences for influences underlying treatment choice. Better understanding these influences may help us present salient information about treatment options to patients and address disparities.
Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: A nationwide Korean survey
2019, Journal of Geriatric Oncology
Citation Excerpt :
The reason for a higher sense of discrimination within the information domain compared with the TDM participation domain might be because some older patients want to be informed of their status and treatment options but that they want to defer the final decision to their physician or family members [12,24]. A sense of discrimination regarding treatment decisions was more common than with regard to the actual treatment received; possibly because older patients consider the less intensive treatment that they tend to receive to be the most appropriate therapy for them, rather than view it as undertreatment [25]. Additionally, some older patients thought they have not received as much attention or supportive care as younger patients did, implying that older people are more sensitive to emotional and supportive care issues than to the actual treatment they receive.
It is not clear whether age-related differences in treatment and treatment decision-making are the result of age discrimination or just a reflection of older patients' elevated risk and their own preferences. Therefore, it is critical to understand older patients' own views toward their care in regard to its relationship to age.
439 older patients with cancer (age ≥ 60) and 358 family members from eleven cancer centers participated in this cross-sectional survey.
Almost all patients (91.2%) and caregivers (92.7%) thought that older patients should be treated equal to younger patients, across all questionnaire items. The proportions of patients who reported having experienced age discrimination according to each item were: disease information (12.3%), treatment information (11.0%), participation in treatment decision (10.7%), attention from healthcare professionals (6.2%), supportive care (5.2%), and treatment (3.2%). Increasing age was the only demographic characteristic that was associated with greater ageism experience (p < .001). Patients' ageism attitudes, as well as caregivers' ageism attitudes, were negatively associated with ageism experience. Ageism experience was associated with a higher depression score, as well as a lower quality of life.
Discrimination in treatment and the treatment decision process based on age was not justified. Interventions that address ageist attitudes in older patients, family caregivers, and healthcare professionals are needed to reduce age discrimination, and thereby improve the quality of life of older patients with cancer.
Understanding health decision making: An exploration of homophily
2018, Social Science and Medicine
The phenomenon of homophily first was described in Lazarsfeld and Merton's classic 1954 friendship analysis as a tendency for friendships to form between those who are alike in some respect. Although theories of decision making address a host of factors that affect the process, the influence of individuals with homophilic ties remains unaccounted for and unexplained. The purpose of this paper is to review theories relevant to decision making and describe what is known about the relationship between homophily and health care decision making. Further, we provide new evidence suggesting the influence of homophily on decision making in results from a randomized, multi-center clinical trial of American men with localized prostate cancer. A diverse sample of 293 men with a new diagnosis of localized prostate cancer reported relevant personal factors influencing the care management decision before randomization to a decision aid or usual care, between 2013 and 2015. Among these personal factors were the level of influence or importance ascribed to various individuals at the time of the treatment decision. One month later, participants reported how prepared they were for decision making. 123 men (42%) reported friends and/or coworkers as information sources, of which 65 (53%) indicated that friends and/or coworkers influenced the care decision. Men who reported friends/coworkers as information sources had significantly higher one-month preparation scores. Our review of decision making theories and practical applicability suggests the influence of homophilic relationships manifests in health care decision making. Faced with a list of options to manage health conditions, decision makers turn to known individuals in their environments, particularly those individuals with whom the decision maker can identify. Clinicians may solicit information from patients about influential others and explain how that support fits into the health decision at hand without dishonoring the importance of the homophilic relationship.
Patients’ perceptions and attitudes on recurrent prostate cancer and hormone therapy: Qualitative comparison between decision-aid and control groups
2017, Journal of Geriatric Oncology
To compare patients' attitudes towards recurrent prostate cancer (PCa) and starting hormone therapy (HT) treatment in two groups—Decision-Aid (DA) (intervention) and Standard-of-care (SoC) (Control).
The present research was conducted at three academic clinics—two in the Midwest and one in the Northeast U.S. Patients with biochemical recurrence of PCa (n = 26) and follow-up oncology visits meeting inclusion criteria were randomized to either the SoC or DA intervention group prior to their consultation. Analysts were blinded to group assignment. Semi-structured phone interviews with patients were conducted 1-week post consultation. Interviews were audio-taped and transcribed. Qualitative analytic techniques were used to extract salient themes and conduct a comparative analysis of the two groups.
Four salient themes emerged—1) knowledge acquisition, 2) decision-making style, 3) decision-making about timing of HT, and 4) anxiety-coping mechanisms. A comparative analysis showed that patients receiving the DA intervention had a better comprehension of Prostate-specific antigen (PSA), an improved understanding of HT treatment implications, an external locus-of-control, participation in shared decision-making and, support-seeking for anxiety reduction. In contrast, SoC patients displayed worse comprehension of PSA testing and HT treatment implications, internal locus-of-control, unilateral involvement in knowledge-seeking and decision-making, and no support-seeking for anxiety-coping.
The DA was more effective than the SoC group in helping PCa patients understand the full implications of PSA testing and treatment; motivating shared decision-making, and support-seeking for anxiety relief. DA DVD interventions can be a useful patient education tool for bringing higher quality decision-making to prostate cancer care.
Less satisfaction with information in patients with prostate cancer treated with surgery and salvage radiotherapy compared with patients treated with curative radiotherapy alone, despite similar health-related quality of life
2014, Clinical Genitourinary Cancer
This study examined patient perception of information received, satisfaction with that information, and its relation to health-related quality of life (HRQoL) and clinical and demographic variables before, during, and after radiotherapy (RT) for localized prostate cancer.
In 2010, 2 questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 [EORTC QLQ-C30] and EORTC QLQ information module [QLQ-INFO25]) were sent to 660 consecutive patients with prostate cancer who had undergone or were to undergo RT with curative intent between December 2006 and March 2010.
The response rate was 92%. Although most patients (69%) were satisfied with the information they received, statistically significant differences were found for all but 2 EORTC QLQ-INFO25 variables, favoring those who were treated with RT alone compared with those treated with both prostatectomy and salvage RT. Statistically significant associations between all HRQoL variables and satisfaction with information were found; higher levels of satisfaction were associated with better functioning and lower levels of symptoms and problems.
Satisfaction with the information received was studied in patients with prostate cancer with localized disease. Despite the fact that the majority of patients reported being satisfied with the information received, there is room for improvement, especially regarding “the disease,” “other services,” “different places of care,” and “things you can do to help yourself.” Patients treated with both prostatectomy and salvage RT reported significantly lower levels of satisfaction with information received and of having received significantly less information than did patients treated with RT alone.
Patient, physician and contextual factors are influential in the treatment decision making of older adults newly diagnosed with symptomatic myeloma
2014, Cancer Treatment Communications
Citation Excerpt :
Age is likely to be an influential factor in TDM by both patients and clinicians. Berry and colleagues [24] found evidence of this in a study of 260 men with localized prostate cancer. A majority (70%) of the study participants reported that their age had influenced their treatment decision, with older men being more likely to eliminate a particular treatment option exclusively because of their advanced age.
To examine patient perspectives on their personal and contextual factors relevant to TDM. The second aim was to describe physician perspectives on the TDM in older adults (≥60 y.o.) diagnosed with symptomatic MM.
Descriptive, cross-sectional.
A semi-structured interview schedule was administered. Directed content analysis procedures were used to develop major themes from the patient and physician participant interviews.
Themes related to treatment decision making among patient participants include various decisional role preferences; several sources of information related to myeloma; contextual and patient-specific factors influence treatment decisions; negative perceptions related to the treatment decision-making process exist; strong desire to be in remission and to live a longer life; For physician participants, top themes related to decision making were: QOL or survival considerations or simultaneously considerations of treatment effectiveness, QOL and survival; screening patients for eligibility for autologous HSCT; time is a barrier to effective TDM; Various methods were used to assess patient decisional role preferences.
Treatment decision making in older adults newly diagnosed with symptomatic myeloma is influenced by personal, social and contextual factors. Patients must be given the opportunity to choose the best possible treatment within the limits of the patient’s personal, social and medical contexts.

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Original ContributionFactors That Predict Treatment Choice and Satisfaction with the Decision in Men with Localized Prostate Cancer

Abstract

Crit Rev Oncol Hematol

Urologic Oncol

Urology

Patient Educ Couns

Int J Radiat Oncol Biol Phys

Why do men choose one treatment over another?: a review of patient decision making for localized prostate cancer

Cancer

Decision-making strategies for patients with localized prostate cancer

Semin Urol Oncol

Validation of a decisional conflict scale

Med Decis Making

State-trait anxiety inventory for adults (Form Y)

Patient satisfaction with health care decisions: the satisfaction with decision scale