Partner's influence on patient preference for treatment in early prostate cancer

Abstract

RESULTSQuestionnaires were sent to 116 eligible patients and 82 were returned for analysis (mean partner age 63 years). When asked to recall the treatment options initially discussed, all partners recalled radiotherapy (EBRT), all but one radical prostatectomy (RP), 51% brachytherapy, but only 29% watchful waiting (WW); 41% of partners stated RP as their chosen option, 37% EBRT, 12% brachytherapy and 10% no clear favourite. None preferred WW. Employment and education status were not significant predictors of partners' preference but retired partners and those aged >65 years were 3 times more likely to prefer EBRT than were their employed and younger counterparts, respectively. The partners' mean (median, SD ) self-assessed influence factor was 4.8 (5, 3.4).Of the partners, 88% reported active involvement throughout the process, identifying information-gathering and emotional support as their primary roles. Most deliberately chose not to influence the patient's final decision. CONCLUSIONPartner preference is influenced by preexisting conceptions about cancer and its treatment. While undoubtedly influential throughout the decision-making process, partners deliberately left the final decision to the patient.

Why do men choose one treatment over another?

“…These included 16 survey studies, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] 16 studies aimed at designing and exploring decision aids, 19 -34 16 focus group studies regarding treatment decision making, [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] 10 studies examining shared decision making between patients and physicians, [51][52][53][54][55][56][57][58][59][60] 6 studies exploring health state preferences associated with treatment decision making, [61][62][63][64][65][66] and 5 review articles related to treatment decision making.…”

“…In 1 study, 70% of men who received a recommendation for surgery selected another therapy. 10 Other studies have found that approximately two-thirds 45 and three-quarters 7 of patients, respectively, see at least 2 physicians.…”

“…Patients and their families have repeatedly reported spending considerable time and energy researching treatment efficacy. 20,42,45,70 Feldman-Stewart et al 59 found that 18 of the top 20 questions reported by newly diagnosed patients were about cancer control.…”

“…5 Fear of side effects was also stated by only 3% of men in a study in North Carolina, in which the majority of patients were black. 8 Srirangam et al 45 reported that although 55% of spouses reported that side effects were important, only 6% indicated that side effects were deciding factors. One study comparing surgery and brachytherapy reported that 25% of patients chose between these 2 options based on the side effect profile.…”

“…26 One study observed that brachytherapy was popular among working patients and their partners. 45 In another study, men who did not choose radiation indicated that they perceived radiation therapy to be time-consuming and disruptive to their daily schedule. 44 One of the reasons that patients cited for selecting external beam radiation therapy or brachytherapy instead of surgery was that they believed it was more convenient than surgery.…”