Factors influencing prostate cancer management preferences – Video abstract 83333

Summary

Dr. 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

00:00

🔍 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.

05:01

👨‍👩‍👧‍👦 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.

Keywords

💡Prostate Cancer

Prostate cancer is a type of cancer that occurs in the prostate, a small gland in males which is a part of the reproductive system. In the video, prostate cancer is the central topic as the study focuses on how patients make decisions regarding its treatment. The script mentions Timothy Showalter's clinical specialty in treating prostate cancer and the various treatment options available to patients.

💡Decision Making

Decision making in the context of the video refers to the process by which patients choose their treatment options for prostate cancer. The script discusses the complexity of this process, with multiple choices ranging from active surveillance to surgery and radiation therapy, and the importance of shared decision making between physicians and patients.

💡Shared Decision Making

Shared decision making is a model of patient care where both the patient and the physician participate in making health decisions. The script highlights national recommendations that suggest physicians and patients should work together to arrive at a decision for prostate cancer treatments, emphasizing the collaborative aspect of healthcare.

💡Active Surveillance

Active surveillance is a treatment approach for some patients with prostate cancer where the disease is monitored closely but not immediately treated with surgery or radiation. The script notes that active surveillance is one of the choices patients have and that family opinion and physician recommendation are significant factors in whether patients choose this option.

💡Treatment Outcomes

Treatment outcomes refer to the results or effects of medical treatments. In the video, the study examines patient preferences for outcomes of prostate cancer treatments, such as the risk of side effects, which is a primary concern for many patients, as mentioned in the script.

💡Systematic Review

A systematic review is a type of research that systematically identifies, evaluates, and interprets all available evidence on a particular topic using a set of predefined criteria. The script describes the study as a systematic review of literature from 1995 to 2012 to understand patient preferences for prostate cancer treatment decisions.

💡PREFS Score

The PREFS score is a scoring system used to evaluate the quality of preference assessment research. Developed by Dr. John Bridges, it helps understand the elements included in published reports and assess the quality of evidence. The script mentions the use of the PREFS score to evaluate the quality of studies included in the review.

💡Risk of Side Effects

The risk of side effects is a critical consideration for patients when deciding on a treatment for prostate cancer. The script discusses how patients weigh the potential side effects, such as impotence, gastrointestinal issues, or urinary incontinence, against the perceived effectiveness of the treatment.

💡Perceived Effectiveness

Perceived effectiveness refers to how patients view the potential of a treatment to cure their condition. The script indicates that some patients value a treatment they believe to be more effective, which may lead them to opt for more invasive procedures over less aggressive options like active surveillance.

💡Family Opinion

Family opinion is highlighted in the script as an influential factor in a patient's treatment decision-making process. It suggests that the perspectives of family members, along with physicians, play a significant role in shaping a patient's choice of treatment for prostate cancer.

💡Physician Recommendation

Physician recommendation is the advice or suggestion given by a doctor to a patient regarding treatment options. The script notes that a physician's recommendation, along with family opinion, is a main driver in whether a patient accepts active surveillance as a treatment option.

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

foreign