Abstract
ObjectiveClinical options for managing nonmetastatic prostate cancer (PCa) vary. Each option has side effects associated with it, leading to difficulty in decision‐making. This study aimed to assess the relationship between patient involvement in treatment decision‐making and subsequent decision regret (DR), and quantify the impact of health‐related quality of life (HRQL) outcomes on DR.MethodsMen living in the United Kingdom, 18 to 42 months after diagnosis of PCa, were identified from cancer registration data and sent a questionnaire. Measures included the Decision Regret Scale (DRS), Expanded Prostate cancer Index Composite short form (EPIC‐26), EQ‐5D‐5L, and an item on involvement in treatment decision‐making. Multivariable ordinal regression was utilized, with DR categorized as none, mild, or moderate/severe regret.ResultsA total of 17 193 men with stage I‐III PCa completed the DRS: 36.6% reported no regret, 43.3% mild regret, and 20.0% moderate/severe regret. The odds of reporting DR were greater if men indicated their views were not taken into account odds ratio ([OR] = 6.42, 95% CI: 5.39‐7.64) or were involved “to some extent” in decision‐making (OR = 4.63, 95% CI: 4.27‐5.02), compared with men who were “definitely” involved. After adjustment, including for involvement, men reporting moderate/big problems with urinary, bowel, or sexual function were more likely to experience regret compared with men with no/small problems. Better HRQL scores were associated with lower levels of DR.ConclusionsThis large‐scale study demonstrates the benefit of patient involvement in treatment decision‐making for nonmetastatic PCa. However, men experiencing side effects and poorer HRQL report greater DR. Promoting engagement in clinical decision‐making represents good practice and may reduce the risk of subsequent regret.
Highlights
Clinical decisions taken by patients and clinicians in choosing treatment strategies for localized and locally advanced prostate cancer (PCa) are complex.[1,2] The range of clinical options that may be appropriate for an individual is diverse, including active surveillance, radical radiotherapy, radical surgery, or androgen deprivation therapy (ADT).[3]
This study aimed to assess the relationship between patient involvement in treatment decision-making and subsequent decision regret (DR), and quantify the impact of health-related quality of life (HRQL) outcomes on DR
With a focus on localized or locally advanced PCa, where men should have some degree of choice over their treatment, we aimed to: 1. assess the relationship between involvement in treatment decision-making and subsequent decision regret, in order to inform best clinical practice at the time of initial treatment decisionmaking; 2. quantify the impact of treatment side effects and HRQL on decision regret
Summary
Clinical decisions taken by patients and clinicians in choosing treatment strategies for localized and locally advanced prostate cancer (PCa) are complex.[1,2] The range of clinical options that may be appropriate for an individual is diverse, including active surveillance, radical radiotherapy, radical surgery, or androgen deprivation therapy (ADT).[3]. Reviews suggest treatment side effects, such as sexual and urinary dysfunction, and the overall level of patient well-being are all associated with decision regret.[4,8] Greater regret has been reported more frequently in patients receiving radical prostatectomy than radical radiotherapy.[4,5] Patient perception of having made an informed choice (response to the question “I had all the information I needed when a treatment was chosen for my prostate cancer”) was shown to be significantly associated with regret when patients were evaluated 15 years after initial decision-making.[7] For diseases other than PCa, key risk factors for decision regret have included the nature of the decision-making process, sociodemographic and treatmentrelated variables, and poor mental health.[5,9,10]. With a focus on localized or locally advanced PCa, where men should have some degree of choice over their treatment, we aimed to: 1. assess the relationship between involvement in treatment decision-making and subsequent decision regret, in order to inform best clinical practice at the time of initial treatment decisionmaking; 2. quantify the impact of treatment side effects (urinary, bowel, and sexual function) and HRQL on decision regret
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