Patient Preference and the Impact of Decision-Making Aids on Prostate Cancer Treatment Choices and Post-Intervention Regret

Abstract

Today, most men who have localized prostate cancer at diagnosis and who undergo either active surveillance or curative treatment can expect to have a disease-specific survival of at least 10 years 2-4 . Even men with metastatic disease can expect increased survival as new therapeutic agents become available and alternative regimes for existing treatments are tried 5,6 . Those facts, combined with an overall life expectancy predicted to reach 81.9 years by 2031 7 , result in the reality of long exposure to the ramifications of prostate cancer treatments for patients and their families alike.The traditional oncologic outcomes of margin status, biochemical recurrence, disease-free survival, and overall survival are no longer sufficient measures of treatment success. The adverse effects of treatment, which can be both functional and psychological, must also be considered. The potential impacts of treatment side effects on quality of life for patients and their partners have to be considered in the informed decision-making process 8 . Thus, the quality of information received by patients and their decision-making before treatment, as well as post-treatment regret, must be studied carefully. As such, this previously informal and subjective area of cancer care is now an evolving research field. In the modern era of shared decision-making, the onus is now on specialists not only to cure the cancer, but also to ensure that patients receive the best quality of life after treatment. The present article examines the treatment preferences of prostate cancer patients, the role of decision-making aids (dmas), and the effect of the use of such aids on post-treatment regret. PATIENT PREFERENCESToday's patients have health-related preferences that go beyond simply being cured of cancer. Understanding those preferences is essential if caregivers are to provide holistic quality of life after treatment. Knowing a patient's particular preferences provides insight into how that patient will approach making treatment ABSTRACTThe number of prostate cancer survivors is rapidly growing in the Western world. As a result of better oncologic outcomes, more patients are living longer with the adverse effects of treatment, which can be both functional and psychological. Clinicians, in an era of shared decision-making, must not only cure the cancer, but also ensure that, after treatment, their patients experience the best quality of life and minimal post-treatment decisional regret. To participate in the decision-making process, men and their involved partners and family need to fully understand the relative benefits and harms of prostate cancer treatments.Patient preference studies indicate that men with prostate cancer are not well informed. Decision-making aids are a positive treatment adjunct both to convey information and to allow patients to explore their own beliefs and values during the decision-making process. The evidence suggests that decision-making aids better prepare patients for involvement in treatment decisions, but further stu...

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