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BJU Int. 2017 Jul;120(1):32-39. doi: 10.1111/bju.13651. Epub 2016 Oct 2.

Qualitative study on decision-making by prostate cancer physicians during active surveillance.

Author information

1
Department of Urology, New York University, New York, NY, USA.
2
Department of Population Health, New York University, New York, NY, USA.
3
Laura and Isaac Perlmutter Cancer Center, New York University, New York, NY, USA.
4
Manhattan Veterans Affairs Medical Center, New York University, New York, NY, USA.
5
Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
6
Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, Salt Lake City VA, UT, USA.
7
Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA.

Abstract

OBJECTIVE:

To explore and identify factors that influence physicians' decisions while monitoring patients with prostate cancer on active surveillance (AS).

SUBJECTS AND METHODS:

A purposive sampling strategy was used to identify physicians treating prostate cancer from diverse clinical backgrounds and geographic areas across the USA. We conducted 24 in-depth interviews from July to December 2015, until thematic saturation was reached. The Applied Thematic Analysis framework was used to guide data collection and analysis. Interview transcripts were reviewed and coded independently by two researchers. Matrix analysis and NVivo software were used for organization and further analysis.

RESULTS:

Eight key themes emerged to explain variation in AS monitoring: (i) physician comfort with AS; (ii) protocol selection; (iii) beliefs about the utility and quality of testing; (iv) years of experience and exposure to AS during training; (v) concerns about inflicting 'harm'; (vi) patient characteristics; (vii) patient preferences; and (viii) financial incentives.

CONCLUSION:

These qualitative data reveal which factors influence physicians who manage patients on AS. There is tension between providing standardized care while also considering individual patients' needs and health status. Additional education on AS is needed during urology training and continuing medical education. Future research is needed to empirically understand whether any specific protocol is superior to tailored, individualized care.

KEYWORDS:

active surveillance; markers; prostate cancer; qualitative; survey

PMID:
27611479
PMCID:
PMC5555310
DOI:
10.1111/bju.13651
[Indexed for MEDLINE]
Free PMC Article

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