The Conflicts of Decision-Making for Localized Prostate Cancer (LPC) Treatments

Prostate cancer is the most commonly diagnosed malignancy among US men. Men diagnosed with LPC, or cancer confined to the organ, are presented with many equally efficacious treatment options, such as radical prostatectomy surgery or radiation treatments, all with specific benefits and side effects. Clinicians often, respecting autonomy in decision making, provide information but do not prescribe therapy, leaving treatment decision-making to patients and families. Understanding these factors and conflicts can help clinicians better guide patient treatment decisions. The aims of this study are to: (1) summarize the specific factors men take into consideration when making the LPC treatment decision, and (2) to identify inherent conflicts of this decision-making process. Methodology included a content, conceptual, secondary data analysis of transcribed interviews from primary study of LPC decision-making.3 Concept categories were established through review of literature. Assessment of interview text using previously established translation rules ascertained factors and conflicts in LPC treatment decision process. These were summarized and corroborated with expert review. For the purpose of this study, factors have been categorized into absolute and relative factors. Analysis reveals that several inherent, multifaceted conflicts persist among these men. The conflicts that surfaced during secondary analysis of 31 individual interviews were thematically categorized into (1) fear of a reduction in quality of life, (2) time urgency, and (3) lack of trust in the physician. Interestingly, if men have had experiences with traumatic family medical histories, especially non-prostate cancer, they were particularly fearful of cancer spread, and some even expressed inaccurate perceptions about prostate cancer treatments. The most prominent conflict appeared to be a lack of trust in the physician and healthcare system, which is categorized further into four subthemes. Many of these conflicts stem from profound past experiences that may require a more comprehensive assessment by clinicians then what is done in a typical doctor visit. Future studies should focus on discovering realistic, cost-effective methods to address patient conflicts and fears. If clinicians wish to individualize care, knowing men heavily rely on personal factors, they must understand the uniqueness of a man's life experience will undoubtedly influence decision-making