A new study by UCLA researchers reported that men who are not well educated about their disease have significant difficulty in making treatment decisions, a situation known as decisional conflict. As a result, this lack of knowledge might compromise the quality of their care and their long-term outcomes. The findings were published online on August 26 in the journal Cancer.
First author Dr. Alan Kaplan, a resident physician in the UCLA Department of Urology, explained that the study should serve as a wake-up call for doctors, who can use the findings to target men who are likely to have limited knowledge about their prostate cancer and educate them prior to their appointments. As a result, they should be more comfortable making treatment decisions. He explained, “For prostate cancer, there is no one right answer when it comes to treatment. It comes down to the right answer for each specific patient, and that is heavily dependent on their own personal preferences. Men in general, and specifically economically disadvantaged men, have a hard time deciding what their preferences are, how they feel about any possible complications and what the future after treatment might be like. If you don’t know anything about your disease, you’ll have a really tough time making a decision.”
The study group comprised 70 men at a Veterans Administration clinic who were newly diagnosed with localized prostate cancer and had enrolled in a randomized trial that tested a new shared decision-making tool. The investigators collected baseline demographic and clinical data such as age, race, education, co-existing medical conditions, relationship status, urinary and sexual dysfunction, and their prostate cancer knowledge.
The investigators engage in one-on-one conversations with the men after they had received their cancer diagnosis, but before they consulted with a doctor. The average age of the men in the study was 63 years, 49% were African American, and 70% reported an annual income of less than $30,000. The researchers found that a low level of prostate cancer knowledge was associated with increased decisional conflict and higher uncertainty about what treatment options to select. Low levels of prostate cancer knowledge also were associated with lower perceived effectiveness, which meant that the less the men knew about their cancer, the less confidence they had that the treatment would be effective.
Dr. Kaplan explained, “Knowledge about prostate cancer is an identifiable target. Interventions designed to increase a patient’s comprehension of prostate cancer and its treatments may greatly reduce decisional conflict.” He added that further study is needed to better characterize this relationship and identify effective targeted interventions. He explained, “If you get shot in the gut, there aren’t many options. You go into the operating room to get fixed up. With prostate cancer, there are lots of options and not all are right for everybody.”
Prostate cancer victims might need to decide between surgery versus radiation or opting for active surveillance, in which they are monitored closely for changes in the progression of their cancer and are tested at regular intervals. Prostate cancers can also be treated implantable radioactive seeds; other options are freezing or cauterizing the tumors may be burned or frozen as treatment. Another benefit from the reduction of decisional conflict is that patients who feel comfortable with their decision may regret their decisions less at a later point in time, noted Dr. Kaplan. He noted, “In a way, it’s like buying a car. You prepare, you read reports, do your homework. If something goes wrong with the car, you feel okay because you knew what you were getting into. When patients take ownership of the decision-making process, their outcomes are better.”
Dr. Kaplan explained that economically disadvantaged men may be having more difficulty because they may not have as much experience negotiating the healthcare system and are less confident when communicating with doctors. He said, “Doctors, we know intuitively, should spend more time with their patients, especially when they’re making an important decision. But all of us are challenged with the numbers of patients we must see in a day. If you know beforehand that a patient has a poor knowledge about his cancer, that’s someone you need to spend more time with.” He added that physicians may also want to provide these patients with educational information before their consultation so that they can begin to increase their prostate cancer knowledge.
Except for skin cancer, prostate cancer is the most frequently diagnosed cancer in men. An estimated 233,000 new cases of prostate cancer will occur in the US in 2014. Of those, nearly 30,000 men will die.