The Treatment Decision-making Preferences of Patients with Prostate Cancer Should Be Recorded in Research and Clinical Routine: a Pooled Analysis of Four Survey Studies with 7169 Patients

Abstract

Different patients want to take different roles in the treatment decision-making process; these roles can be classified as passive, collaborative, and active. The aim of this study was to investigate the correlation between decision-making preferences among patients with prostate cancer and personal, disease-related, and structural factors. In four survey studies, we asked 7169 prostate cancer patients about their decision-making preferences using the Control Preferences Scale (CPS) and collected clinical, psychological, and quality-of-life measures. Most patients (62.2%) preferred collaborative decision-making, while 2322 (32.4%) preferred an active role, and only 391 (5.5%) preferred a passive role. Age (p < 0.001), data collection mode (p < 0.001), peer-to-peer support (p = 0.018), treatment status (p < 0.001), performed or planned radical prostatectomy (p < 0.001), metastatic disease (p = 0.001), and quality of life (p < 0.001) showed significant associations with patients’ preferred decision-making roles. Oncologic risk group, anxiety, and depression were not significant in the model. In particular, younger prostate cancer patients with higher quality of life completing an online survey want to play a more active role in treatment decision-making. Before treatment has started, patients tend to prefer collaborative decision-making. Few prostate cancer patients in Germany prefer a passive role. These patients are mostly older patients, patients with a metastatic disease, and patients who have opted for prostatectomy. Whether this finding reflects a generational effect or a tendency by age group and disease phase should be investigated. Further research is also needed to describe the causalities of these relationships. The CPS offers valuable information for personal counselling and should be applied in clinical routine. In a large group of patients with prostate cancer, we found that there is a strong desire for joint decision-making with the physician before the actual treatment. Especially younger men, men with active online behaviour, and men with a high quality of life want to be actively involved in therapy decision-making processes.

Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making

“… 36 Patients' decision making preferences are a valuable information and should be regularly assessed and applied in clinical practice. 9 Our results demonstrate that physicians should especially support and engage more anxious patients during decision making. It is well known that effective responses to patients' informational and emotional needs can reduce distress in cancer patients.…”

“…While a recent study on patient participation in urology suggests high levels of overall patient involvement and satisfaction, many patients still report not having been explicitly asked about their preferred involvement in decision making 36 . Patients' decision making preferences are a valuable information and should be regularly assessed and applied in clinical practice 9 . Our results demonstrate that physicians should especially support and engage more anxious patients during decision making.…”

“…In uro‐oncological samples, about 30% of patients typically report elevated anxiety levels 7 . While recent studies have established a link between negative affect and adverse decision outcomes, 7,8 an association between negative affect and participation preference has not been demonstrated 9 . Moreover, the influence of anxiety on treatment preferences has not been examined thoroughly.…”

Improving access to oncology publications for advocates and people with cancer

“…Increasingly, studies are establishing that many people with cancer want to be involved in shared decision making with their health care providers. 1 , 2 , 3 This approach may be associated with positive effects on a person's quality of life, improved emotional outcomes, reduced health care use, and better treatment satisfaction. 4 , 5 , 6 , 7 Conversely, a passive role in decision making may be associated with more unmet expectations and decisional regret.…”

Decision-Making Preferences in a Palliative Setting in Jordan

“…In another pooled analysis of four studies to assess the preferred decisional making approach among 7169 German patients with prostate cancer, the majority of patients (62.2%) preferred shared decisional making. In addition, younger patients with high quality of life scores opted for an active decision-making approach [12].…”