Med Decis Making - Decision-making Processes among Prostate Cancer Survivors with Rising PSA Levels: Results from a Qualitative Analysis.

Tópicos

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Resumo

CKGROUND: Prostate cancer survivors with a rising prostate-specific antigen (PSA) level have few treatment options, experience a heightened state of uncertainty about their disease trajectory that might include the possibility of cancer metastasis and death, and often experience elevated levels of distress as they have to deal with a disease they thought they had conquered. Guided by self-regulation theory, the present study examined the cognitive and affective processes involved in shared decision making between physicians and patients who experience a rising PSA after definitive treatment for prostate cancer.METHODS: In-depth interviews were conducted with 34 prostate cancer survivors who had been diagnosed with a rising PSA (i.e., biochemical failure) within the past 12 months. Survivors were asked about their experiences and affective responses after being diagnosed with a rising PSA and while weighing potential treatment options. In addition, patients were asked about their decision-making process for the initial prostate cancer treatment.RESULTS: Compared with the initial diagnosis, survivors with a rising PSA reported increased negative affect following their diagnosis, concern about the treatability of their disease, increased planning and health behavior change, heightened levels of worry preceding doctor appointments (especially prior to the discussion of PSA testing results), and a strong reliance on physicians' treatment recommendations.CONCLUSIONS: Prostate cancer survivors' decision-making processes for the treatment of a rising PSA are markedly different from those of the initial diagnosis of prostate cancer. Because patients experience heightened distress and rely more heavily on their physicians' recommendations with a rising PSA, interactions with the health care provider provide an excellent opportunity to address and assist patients with managing the uncertainty and distress inherent with rising PSA levels.

Resumo Limpo

ckground prostat cancer survivor rise prostatespecif antigen psa level treatment option experi heighten state uncertainti diseas trajectori might includ possibl cancer metastasi death often experi elev level distress deal diseas thought conquer guid selfregul theori present studi examin cognit affect process involv share decis make physician patient experi rise psa definit treatment prostat cancermethod indepth interview conduct prostat cancer survivor diagnos rise psa ie biochem failur within past month survivor ask experi affect respons diagnos rise psa weigh potenti treatment option addit patient ask decisionmak process initi prostat cancer treatmentresult compar initi diagnosi survivor rise psa report increas negat affect follow diagnosi concern treatabl diseas increas plan health behavior chang heighten level worri preced doctor appoint especi prior discuss psa test result strong relianc physician treatment recommendationsconclus prostat cancer survivor decisionmak process treatment rise psa mark differ initi diagnosi prostat cancer patient experi heighten distress reli heavili physician recommend rise psa interact health care provid provid excel opportun address assist patient manag uncertainti distress inher rise psa level

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