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Patient Educ Couns. 2019 Feb 18. pii: S0738-3991(19)30067-9. doi: 10.1016/j.pec.2019.02.017. [Epub ahead of print]

Robot or radiation? A qualitative study of the decision support needs of men with localised prostate cancer choosing between robotic prostatectomy and radiotherapy treatment.

Author information

1
Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia. Electronic address: Ben.smith@unsw.edu.au.
2
Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, Australia. Electronic address: o.rincones@unsw.edu.au.
3
South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia. Electronic address: mark.Sidhom@health.nsw.gov.au.
4
South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Department of Urological Surgery, South Western Sydney Local Health District, Liverpool, Australia. Electronic address: p.mancuso@unsw.edu.au.
5
South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia. Electronic address: Karen.Wong4@health.nsw.gov.au.
6
South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia. Electronic address: megan.Berry@health.nsw.gov.au.
7
Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia; School of Medicine, Western Sydney University, Penrith, Australia. Electronic address: dion.Forstner@genesiscare.com.
8
Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, Australia; Division of Surgery, South Western Sydney Local Health District, Liverpool, Australia. Electronic address: les.Bokey@health.nsw.gov.au.
9
Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia. Electronic address: afaf.girgis@unsw.edu.au.

Abstract

OBJECTIVE:

To understand how best to support men diagnosed with localised prostate cancer to decide which treatment option best suits their needs, when robotic prostatectomy and radiotherapy are equally appropriate to offer them.

METHODS:

Twenty-five men recently diagnosed with localised prostate cancer completed semi-structured interviews asking about information/decision-making needs before and/or after attending a combined clinic in which they consulted a urologist and a radiation oncologist regarding treatment options. Data was transcribed verbatim and thematically analysed.

RESULTS:

Most men preferred robotic prostatectomy pre-combined clinic and chose it afterwards. The thematic analysis revealed four themes: 1) trust in clinicians and the information they provide is critical for treatment choice, 2) perceived fit between treatment characteristics and personal circumstances, 3) additional considerations: specific side effects, socio-emotional and financial factors, and 4) need for tailored information delivery. Robotic prostatectomy was mistakenly believed to provide a more definitive cure than radiotherapy, which was seen as having a lesser lifestyle impact.

CONCLUSIONS:

Treatment choice is largely dependent on clinicians' (mainly urologists') recommendations.

PRACTICE IMPLICATIONS:

Patients need more balanced information about alternatives to robotic prostatectomy earlier in the treatment decision-making process. Referral to a radiation oncologist or combined clinic shortly after diagnosis is recommended.

KEYWORDS:

Oncology; Prostate cancer; Qualitative; Radiotherapy; Robotic prostatectomy; Shared decision-making; Treatment decision-making

PMID:
30803903
DOI:
10.1016/j.pec.2019.02.017

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