Better-Informed Decision-Making to Optimize Patient Selection

Published on Jan 1, 2018
· DOI :10.1007/978-3-319-62710-6_14
Lara Bellardita10
Estimated H-index: 10
,
Paola Dordoni2
Estimated H-index: 2
+ 2 AuthorsRiccardo Valdagni51
Estimated H-index: 51
(University of Milan)
Sources
Abstract
The journey of men diagnosed with low-volume, potentially non-aggressive prostate cancer may be a multifaceted one. In fact, from the moment of diagnosis, patients deal with the opportunity and burden of choosing among multiple therapeutic/observational strategies that differ in terms of clinical and personal costs and benefits. The treatment/active surveillance decision can be an initially counterintuitive one and feelings of disorientation could emerge. Based on existing literature and our experience within a multidisciplinary setting, this chapter aims to highlight how prostate cancer patients choose active surveillance and how clinicians and care staff can support men in making an aware choice. First, we introduce the main features that impact on the decision-making process and how they interact both at cognitive and emotional level. Then, we discuss the main barriers for men to choose active surveillance, including physicians’ pressures, family worries and individual sense of uncertainty. Information and shared decision-making – with physicians serving as co-drivers – both supported by the use of decisional aids, are discussed as milestones in the patients’ journey that can improve the selection in active surveillance, above all when active surveillance is presented within a multidisciplinary context. In order to approach patients starting from a collaborative and multidisciplinary approach, physicians need to step beyond their cultural and professional background and acquire adequate communication skills through ad hoc training programs. In conclusion, to improve patient selection in active surveillance, both the patients and the medical care staff need to shift to a perspective of collaboratively sharing their own perspective and experiences during the journey.
📖 Papers frequently viewed together
16 Citations
5 Citations
2015
2 Citations
References124
Newest
#1Ronald E. Myers (Thomas Jefferson University)H-Index: 54
#2Amy Leader (Thomas Jefferson University)H-Index: 14
Last. Leonard G. Gomella (Thomas Jefferson University)H-Index: 80
view all 16 authors...
This study aimed to explore the effects of a decision support intervention (DSI) and shared decision making (SDM) on knowledge, perceptions about treatment, and treatment choice among men diagnosed with localized low-risk prostate cancer (PCa). At a multidisciplinary clinic visit, 30 consenting men with localized low-risk PCa completed a baseline survey, had a nurse-mediated online DS session to clarify preference for active surveillance (AS) or active treatment (AT), and met with clinicians for...
8 CitationsSource
#1Dawn Stacey (Ottawa Hospital Research Institute)H-Index: 56
#1Annette M. O'Connor (U of O: University of Ottawa)H-Index: 77
Last. David R. RovnerH-Index: 37
view all 10 authors...
Background Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. Objectives To assess the effects of decision aids for people facing treatment or screening decisions. Search methods For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to Septe...
3,929 CitationsSource
#1Louie E. Ross (A&T: North Carolina Agricultural and Technical State University)H-Index: 3
#2Daniel L. Howard (A&M: Texas A&M University)H-Index: 2
Last. Thomas A. LaVeist (Johns Hopkins University)H-Index: 65
view all 7 authors...
The objective of this study is to examine factors among a group of African American and White men in North Carolina and their assessment of prostate cancer treatment choice or belief that treatment chosen was best. A sample of men (N = 877) with a history of prostate cancer diagnosis was recruited from the North Carolina Cancer Registry during 2007–2008 and asked to participate in a telephone interview covering several measures about their initial prostate cancer treatment. Logistic regression w...
7 CitationsSource
The patient's role in medical decision making is often not matched to the clinical circumstances: rather than making strong recommendations when there's greater certainty and allowing patients to decide when there's greater uncertainty, we should do the opposite.
88 CitationsSource
#1Yen-Chi L. LeH-Index: 10
#2Stephanie L. McFallH-Index: 10
Last. Patricia Dolan MullenH-Index: 62
view all 7 authors...
The objective of our study was to describe decision making by men and their partners regarding active surveillance (AS) or treatment for early-stage, localized prostate cancer. Fifteen couples were recruited from a cancer center multispecialty clinic, which gave full information about all options, including AS. Data were collected via individual, semi-structured telephone interviews. Most patients were white, non-Hispanic, had private insurance, had completed at least some college, and were aged...
10 CitationsSource
#1Stephanie L. McFall (University of Essex)H-Index: 10
#2Patricia Dolan Mullen (University of Texas at Austin)H-Index: 62
Last. Robert J. Volk (University of Texas MD Anderson Cancer Center)H-Index: 56
view all 8 authors...
Objective: Few decision aids emphasize active surveillance (AS) for localized prostate cancer. Concept mapping was used to produce a conceptual framework incorporating AS and treatment. Methods: Fifty-four statements about what men need to make a decision for localized prostate cancer were derived from focus groups with African American, Latino and white men previously screened for prostate cancer and partners (n = 80). In the second phase, 89 participants sorted and rated the importance of stat...
10 CitationsSource
#1Prajakta Adsul (SLU: Saint Louis University)H-Index: 6
#2Ricardo J. Wray (SLU: Saint Louis University)H-Index: 17
Last. Sameer Siddiqui (SLU: Saint Louis University)H-Index: 17
view all 6 authors...
Purpose: Despite established evidence for using patient decision aids, use with newly diagnosed patients with prostate cancer remains limited partly due to variability in aid characteristics. We systematically reviewed decision aids for newly diagnosed patients with prostate cancer.Materials and Methods: Published peer reviewed journal articles, unpublished literature on the Internet and the Ottawa decision aids web repository were searched to identify decision aids designed for patients with pr...
34 CitationsSource
#1Heather Orom (UB: University at Buffalo)H-Index: 23
#2Christian J. Nelson (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 47
Last. Deepak A. KapoorH-Index: 1
view all 5 authors...
Objective Early identification and intervention have been recommended for newly diagnosed prostate cancer patients who experience significant emotional distress; however, there is little empirical basis for designing or selecting interventions for these men. We sought to identify factors that are associated with distress in these men as a basis for identifying suitable intervention strategies. Methods Using cross-sectional data and validated scales, we investigated the extent to which clinical, ...
36 CitationsSource
#1Martin Härter (UHH: University of Hamburg)H-Index: 68
#2Angela BuchholzH-Index: 13
Last. Christiane BieberH-Index: 19
view all 9 authors...
Shared decision making has become increasingly important in oncology (1). It can be defined as a decision making process in which patient and health-care provider discuss possible treatment options and come to a joint decision (2). Studies show that decision aids support shared decision making in oncology by increasing confidence in the decision, knowledge of treatment options, and patients’ satisfaction with the decision (3– 5). Few physicians yet feel that they have received sufficient trainin...
44 CitationsSource
#1Riccardo ValdagniH-Index: 51
#2Hendrik Van Poppel (Katholieke Universiteit Leuven)H-Index: 82
Last. Alberto CostaH-Index: 49
view all 29 authors...
The Prostate Cancer Programme of the European School of Oncology developed the concept of specialised interdisciplinary and multiprofessional prostate cancer care to be formalized in Prostate Cancer Units (PCU). After the publication in 2011 of the collaborative article "The Requirements of a Specialist Prostate Cancer Unit: A Discussion Paper from the European School of Oncology", in 2012 the PCU Initiative in Europe was launched. A multiprofessional Task Force of internationally recognized opi...
20 CitationsSource
Cited By0
Newest
Background The psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer (PCa) could be a potential disadvantage of active surveillance (AS), especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen (PSA) test, and medical examination]. Even if it is known from the literature that the majority of PCa men in AS do not report heightened anxiety, there is a minority of patients who show clinically significan...
Source