Factors influencing prostate cancer management preferences – Video abstract 83333
Summary
TLDRDr. Timothy Showalter from the University of Virginia Cancer Center discusses his study on prostate cancer treatment decision-making, highlighting the complexity of choices for patients. His systematic review of literature from 1995 to 2012 identifies patient priorities, such as the risk of side effects and the perceived effectiveness of treatment. The study emphasizes the importance of shared decision-making involving physicians and family, particularly in the acceptance of active surveillance as a treatment option.
Takeaways
- 👨⚕️ Timothy Showalter's primary clinical specialty is in prostate cancer, where he observes the complexity of treatment decisions for patients.
- 🤔 Prostate cancer patients face a multitude of treatment options, including active surveillance, surgery, and various radiation therapies.
- 🤝 National recommendations encourage shared decision-making between physicians and patients for prostate cancer treatments.
- 🔍 The study is a systematic review of literature from 1995 to 2012, aiming to understand patient preferences for prostate cancer treatment decisions.
- 📚 The review analyzed 21 articles representing over 4,000 patients' perspectives on their treatment decision-making process.
- 🏆 A scoring system called PREFS was used to evaluate the quality of the studies, showing good scores compared to other preference assessments.
- 🌎 The study had a high representation of U.S. patients, which may not fully represent global perspectives.
- 💡 The risk of side effects was a top priority for patients, with variability in concerns such as impotence, gastrointestinal effects, or urinary incontinence.
- 🛡️ Some patients highly value the perceived effectiveness of the treatment and are less likely to opt for non-invasive options like active surveillance.
- 👨👩👧👦 Family opinions and physician recommendations play a significant role in the treatment decision-making process, especially for active surveillance.
- 📈 The findings suggest that improving the decision-making process should involve a shared dialogue among physicians, family members, and patients.
Q & A
What is Timothy Showalter's primary clinical specialty?
-Timothy Showalter's primary clinical specialty is in prostate cancer.
Why are prostate cancer treatment decisions considered complex for patients?
-Prostate cancer treatment decisions are complex due to the multitude of choices available, ranging from active surveillance to surgery and various radiation therapy options.
What is the role of shared decision-making in prostate cancer treatment according to national recommendations?
-National recommendations suggest that physicians and patients should work together to arrive at a shared decision for prostate cancer treatments.
What was the goal of Timothy Showalter's study?
-The goal of the study was to review existing medical evidence to better understand patient preferences for prostate cancer treatment decisions.
How did the study approach the review of literature on prostate cancer?
-The study conducted a systematic review of available published literature from 1995 to 2012, starting with over 600 titles and narrowing down to 21 articles.
What does the PREFS score evaluate in preference assessment research?
-The PREFS score evaluates the quality of preference assessment research by understanding which elements are included in the published report and assessing the quality of the evidence presented.
What were some characteristics of the studies included in the review?
-The studies included a high representation of patients from the United States, high funding from governmental sources or academic foundations, and low industry funding, suggesting a low risk of bias.
What was the primary concern for patients when making prostate cancer treatment decisions according to the study?
-The primary concern for patients was the risk of side effects related to the cancer treatment, with variability in the specific side effects that were of most concern.
How do patients perceive the effectiveness of treatment in relation to their decision-making process?
-Some patients strongly value choosing a treatment they perceive as more effective for curing their prostate cancer, making them less likely to opt for non-invasive treatments like active surveillance.
What role do family members and physicians play in a patient's treatment decision-making process?
-Family members and physicians play a significant role in the treatment decision-making process, with their perspectives being incredibly important, especially in the acceptance of active surveillance as a treatment option.
What insights can patients and physicians gain from the findings of this study?
-Patients can gain insights into the common themes and priorities that guide treatment decisions, while physicians can use this information to improve the decision-making process and involve family members in a shared dialogue.
Outlines
🔍 Prostate Cancer Treatment Decisions: A Complex Process
Dr. Timothy Showalter from the University of Virginia Cancer Center discusses his study on prostate cancer decision-making, published in the journal Patient Preference and Adherence. The study aims to understand patient preferences for prostate cancer treatment, given the complexity of choices ranging from active surveillance to surgery and radiation therapy. Dr. Showalter highlights the challenge of aligning individual patient priorities with national recommendations for shared decision-making between physicians and patients. The systematic review of literature from 1995 to 2012 included 21 articles representing over 4,000 patients' perspectives, using the PREFS score to evaluate study quality. Key findings include the high priority patients place on minimizing treatment side effects and the influence of perceived treatment effectiveness on their choices. The study also underscores the importance of family and physician opinions in the decision-making process.
👨👩👧👦 The Impact of Family and Physician Perspectives on Prostate Cancer Treatment Choices
This paragraph delves into the implications of the study's findings for both patients and physicians. For patients, the research provides a summary of themes that guide treatment decisions, potentially helping them articulate their feelings about outcomes and understand reasons behind different treatment choices. It emphasizes the role of physician conversations and family members in the decision-making process. For physicians, the study offers insights into how decisions are made, aiding in education and training. Dr. Showalter suggests that interventions to improve the decision-making process should involve a shared dialogue among physicians, family members, and patients. The study concludes that efforts to enhance patient satisfaction with their treatment decisions should consider involving all parties whose opinions matter to the patient.
Mindmap
Keywords
💡Prostate Cancer
💡Decision Making
💡Shared Decision Making
💡Active Surveillance
💡Treatment Outcomes
💡Systematic Review
💡PREFS Score
💡Risk of Side Effects
💡Perceived Effectiveness
💡Family Opinion
💡Physician Recommendation
Highlights
Timothy Showalter's study focuses on prostate cancer decision-making complexities.
Localized prostate cancer patients face multiple treatment options.
National recommendations suggest shared decision-making between physicians and patients.
The study aims to understand patient preferences for prostate cancer treatment decisions.
A systematic review of literature from 1995 to 2012 was conducted.
21 articles were selected, representing over 4,000 patients' perspectives.
The PREFS score system was used to evaluate the quality of studies.
Studies were of relatively high quality compared to other preference assessments.
Most studies were from the United States, potentially underrepresenting global perspectives.
Funding was primarily from governmental sources, indicating low risk of bias.
Risk of side effects is a top priority for patients in treatment decisions.
Patient preferences vary between risks of impotence, gastrointestinal effects, and urinary incontinence.
Some patients prioritize treatment perceived as more effective for curing prostate cancer.
Family opinions and physician recommendations significantly influence treatment choices.
Active surveillance acceptance is driven by family and physician input.
Research provides a framework for understanding patient treatment decision reasons.
Physicians should involve family members in the shared decision-making process.
The study suggests the need for interventions to improve the decision-making process.
Transcripts
we're here with Timothy Showalter of the
University of Virginia Cancer Center to
talk about his study looking at prostate
cancer decision making published in the
journal patient preference and adherence
to show Walter if you would please tell
us about the idea behind the study and
the reason for it well my primary
clinical specialty is in prostate cancer
and I see a lot of prostate cancer
patients and one theme that is very true
is that prostate cancer treatment
decisions are really complex for most
patients with localized prostate cancer
there are multitude of choices they
range from active surveillance or close
observation to surgery to various
radiation therapy options and in
counseling patients it's often difficult
to help them arrive at the right
decision
it's there are National recommendations
that suggest that Physicians and
patients should work together to arrive
at a shared decision for prostate cancer
treatments however it's often a
challenge to really understand
what are the priorities for an
individual patient in in the counseling
process and and what are the really
primary themes that should guide that
discussion so because of that my goal
was to review the existing medical
evidence to better understand patient
preferences for prostate cancer
treatment decisions in hopes that I
could provide some insight to help with
prostate cancer patients and their
Physicians
can you tell us about that and give us
an overview of the study sure so this
study was a systematic review of the
available published literature so we
looked at any published uh papers on
prostate cancer that reported primary
research from the years of 1995 to 2012.
we started off by reviewing over 600
titles that we identified on a
literature search and ultimately arrived
at a final set of 21 articles and those
21 articles represent the perspectives
of over 4 000 prostate cancer patients
and how they process their prostate
cancer treatment decisions and what
their priorities and preferences were
for treatment outcomes you would please
tell us about your main findings yeah so
first off we identified 21 articles
during the study period that met our
specific search criteria and they were
included in the final analysis this
includes the perspective of over four
thousand men facing who are faced with a
prostate cancer treatment decision we
found a relatively high quality of
studies in the published literature and
in order to evaluate quality and sort of
better understand the existing
literature we used a scoring system
called the prefs score which was
developed by my colleague Dr John
Bridges at Johns Hopkins University
School of Public Health and this rating
system is is useful for preference
assessment research and it helps us to
understand which elements are included
in the published report and to evaluate
the quality of the evidence as presented
to the reader and we found a relatively
good scores compared to other published
examples of preference assessment in
diabetes and in breast cancer as well so
that was our starting point for
understanding what the overall quality
of the papers were we next looked at
some characteristics of the studies such
as funding source and where the patients
come from we did find a high
representation of patients from the
United States in the research for me as
a practitioner of course that's valuable
but it's possible that it
underrepresents the perspectives of men
in other countries and we found a high
rate of funding from governmental
courses or academic foundations and a
low rate of Industry funding in the
studies suggesting a low low risk of
bias in the published findings and
importantly there were some primary
themes we identified many of the
respondents reported that their number
one priority was the risk of side
effects related to the cancer treatment
which isn't surprising to me and
depending on the the individual patient
whose perspective was was asked either
the risk of impotence or the risks of
gastrointestinal effects like diarrhea
or the risk of urinary incontinence
could be the number one priority so
there was some variability there and
then on the other hand some patients
really strongly value choosing the
treatment that they perceive as more
effective for curing their prostate
cancer and in general those men are less
likely to turn down
a invasive treatment like radiation or
surgery and they're more likely to to
opt to choose a treatment other than
active surveillance and then another
interesting theme that we identified was
that for many patients the perspectives
of their family members and the
Physicians that they consult with and
respect is incredibly important to the
treatment decision making process in
particular we found a few studies that
looked at how patients feel about active
surveillance as an option and we found
that family opinion and physician
recommendation were main drivers on
whether or not they accepted active
surveillance as a treatment option
so what do these findings mean for
patients then what should they take from
this so I think for patients the primary
value of research like this is that it
really summarizes the themes uh for the
guide treatment decisions for other
patients with prostate cancer it could
potentially help articulate uh ones of
one's feelings about prostate cancer
treatment outcomes and it can provide
some framework for understanding uh you
know what are what are the sorts of
reasons why people may choose one
treatment or the other I think it also
gives some perspective on the level of
involvement of physician conversations
and family members in their treatment
decision process and what about for you
as a physician well for me as a
physician I think it's it's really
useful information it's also helpful in
educating our physicians and training as
well to understand how these sorts of
decisions are made I'm particularly
interested in interventions to help
guide and improve the decision-making
process for prostate cancer patients and
one of the primary conclusions of This
research is simply that any efforts that
are going to be made to improve the
information we have to help patients
really make a decision that they're
happy with really ought to involve the
Physicians that they're they're in
consult with as well as their family
members to really have a shared dialogue
among all the participants whose opinion
matters to the patients well thank you
for talking with us thank you
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