Treatment Decision-Making in Metastatic Prostate Cancer: Perceptions of Locus of Control Among Patient, Caregiver, and Physician Triads

Men's experiences of decision-making in life-prolonging treatments of metastatic castration-resistant prostate cancer - wishing for a process adapted to personal preferences: a prospective interview study

BACKGROUND

In the fast-expanding field of life-prolonging-treatment of metastatic, castration-resistant prostate cancer, treatment decision-making is very complex - both for patients and healthcare professionals since there is no "one size that fits all" in choosing treatment in this phase. Little research has been conducted about men's experiences of treatment decision-making in this advanced, incurable, phase. Hence, this study aimed to describe men's experiences of decision-making in life-prolonging treatments of metastatic castration-resistant prostate cancer.

METHODS

Seventeen men were recruited from four oncology clinics in Sweden and interviewed at baseline. Qualitative interviews (n = 31) were conducted over two years, the timepoints for subsequent interviews (10 men were interviewed twice or more) adhered to when each man switched or terminated life-prolonging treatment. Data was analysed with qualitative content analysis.

RESULTS

Initially, the men were adamant about proceeding with treatment. As their illness continued to progress, they gradually turned their focus more towards their well-being. They wished for continuity regarding treating physicians and constantly being assigned new physicians compromised the quality of care and complicated decision-making. In their decision-making, the men adapted their own approach to the approach taken by their physician, even if it was not an approach they had originally preferred. They wished for their role preferences to be respected. Most men had made treatment decisions collaboratively with their physician, but some described having taken on a more, or less, driving role in decision-making than they really wished for. Navigating healthcare was perceived as difficult and for some it thus felt necessary to pursue and coordinate their own care by e.g. using personal connections or contacting clinics ahead of referral. A part of treatment decision-making was forming a basis for a decision, in which the need for personalized information (quality, quantity and timing) came forth as important.

CONCLUSIONS

When diagnosed with metastatic castration-resistant prostate cancer, men's preferences for their decision-making role, and perspectives on the treatment outcome need to be continuously addressed throughout their disease course. Improved continuity of care and a more personalised care approach should meet these patients' wishes and needs in this phase.

TRIAL REGISTRATION

Clinical trial number: Not applicable.

Enhancing Doctor-Patient Shared Decision-Making: Design of a Novel Collaborative Decision Description Language

BACKGROUND

Effective shared decision-making between patients and physicians is crucial for enhancing health care quality and reducing medical errors. The literature shows that the absence of effective methods to facilitate shared decision-making can result in poor patient engagement and unfavorable decision outcomes.

OBJECTIVE

In this paper, we propose a Collaborative Decision Description Language (CoDeL) to model shared decision-making between patients and physicians, offering a theoretical foundation for studying various shared decision scenarios.

METHODS

CoDeL is based on an extension of the interaction protocol language of Lightweight Social Calculus. The language utilizes speech acts to represent the attitudes of shared decision-makers toward decision propositions, as well as their semantic relationships within dialogues. It supports interactive argumentation among decision makers by embedding clinical evidence into each segment of decision protocols. Furthermore, CoDeL enables personalized decision-making, allowing for the demonstration of characteristics such as persistence, critical thinking, and openness.

RESULTS

The feasibility of the approach is demonstrated through a case study of shared decision-making in the disease domain of atrial fibrillation. Our experimental results show that integrating the proposed language with GPT can further enhance its capabilities in interactive decision-making, improving interpretability.

CONCLUSIONS

The proposed novel CoDeL can enhance doctor-patient shared decision-making in a rational, personalized, and interpretable manner.

A cross-sectional analysis to characterise treatment decision making for advanced cancer at a tertiary treatment centre: Where can we improve the process?

PURPOSE

In decisions relating to cancer treatment, the risks and benefits of treatment and the patient's preferences must be considered to ensure concordance with goals of care. Shared decision making (SDM) can facilitate these discussions and is associated with reduced decision conflict. This study aimed to characterise decision making for advanced cancer patients at a UK tertiary cancer centre and identify who may be at risk of suboptimal SDM and increased decision conflict.

METHODS

Participants completed the SDM-Q-9, decision conflict and decision self-efficacy scale following a consultation where an advanced cancer treatment decision was made. Pearson's chi-square test identified patient characteristics associated with SDM-Q-9, decision self-efficacy and decision conflict score categories; odds ratios were calculated to determine which patients were at increased probability of experiencing suboptimal SDM, low decision self-efficacy or high decision conflict.

RESULTS

Participant's (n = 211) scores indicated predominantly high SDM, high decision self-efficacy and low decision conflict. Patient gender and the presence of an informal caregiver in consultation were significantly associated with SDM-Q-9 score category (p > 0.05). Female patients (OR = 2.466, 95% CI: 1.223-4.974) and those attending consultations alone (OR = 0.440, 95% CI: 0.222-0.874) had greater odds of reporting lower SDM scores.

CONCLUSION

High SDM scores indicate either effective SDM behaviours or satisfaction with care biasing responses. Greater support to engage with SDM is required for female patients and those who attend alone in advanced cancer treatment decision consultations.

Factors Guiding Clinical Decision-Making in Genitourinary Oncology

INTRODUCTION

Clinical decision-making in oncology is a complex process, with the primary goal of identifying the most effective treatment tailored to individual cancer patients. Many factors influence the treatment decision: disease- and patient-specific criteria, the increasingly complex treatment landscape, market authorization and drug availability, financial aspects, and personal treatment expertise. In the domain of genitourinary cancers, particularly prostate cancer, decision-making is challenging. Despite the prevalence of this malignancy, there are few in-depth explorations of these factors within real-world scenarios. Understanding and refining this intricate decision-making process is essential for future successful clinical decisions and the integration of computerized decision support into clinicians' workflows.

AIM

The objective of this study is to improve the current knowledge base and evidence of the factors that influence treatment decision-making for patients with genitourinary cancers.

METHODS

Assessment of how routine treatment decisions are made for genitourinary cancers was performed by a mixed-methods study, encompassing field observations and focus group discussions.

RESULTS

In total, we identified 59 factors that influence clinical decision-making in oncology, specifically for genitourinary and prostate cancer. Of these, 23 criteria can be classified as decision-maker-related criteria encompassing personal, cognitive, and emotional attributes and factors of both, healthcare professionals and patients. Moreover, 20 decision-specific criteria have been identified that refer to clinical and disease-related factors, followed by 16 contextual decision factors that describe the relevant criteria introduced by the specific circumstances and environment in which the treatment decision is made.

CONCLUSION

By presenting an exhaustive set of decision factors and providing specific examples for genitourinary cancers, this observational study establishes a possible framework for a better understanding of decision-making. Moreover, we specify and expand the set of decision factors, while emphasizing the importance of cognitive, emotional, and human factors, as well as the quality and accessibility of decision-relevant information.

Toward a new personalized psycho-social approach for the support of prostate cancer and their caregivers dyads: a pilot study

Introduction

Prostate cancer patients (PCP) often struggle with a significant emotional, physical, and social burden during the care-flow pathway. Noteworthy, PCP should not be considered a standalone patient, but someone who is connected with a relevant social environment and that is usually supported by a beloved one, the caregiver. The involvement of the caregivers through the care pathway might bring significant benefits both on the psychological and the treatment and decision-making side. The present pilot study aimed at preliminarily assessing quantitatively the psychological impact of a prostate cancer diagnosis on the degree of agreement of PCPs and their caregivers on medical decisions, coping resources and psychological distress levels.

Methods

16 PCP and their caregivers were enrolled in the study and fulfilled a battery of standardized questionnaires.

Results

Results showed low concordance in decision making styles and preferences in patients and their caregivers and that the dyads showed similar depression symptoms levels. Relevant features of the psychological needs of the analyzed dyads, such as need for information and support, also emerged.

Conclusion

On the basis of these preliminary results, guidelines for the construction of tailored brief psychological support interventions for PCP dyads are provided.

Patient-Caregiver Portal System in Palliative Oncology: Assessment of Usability and Perceived Benefit

BACKGROUND

The engagement of family caregivers in oncology is not universal or systematic.

OBJECTIVE

We implemented a process intervention (ie, patient-caregiver portal system) with an existing patient portal system to (1) allow a patient to specify their caregiver and communication preferences with that caregiver, (2) connect the caregiver to a unique caregiver-specific portal page to indicate their needs, and (3) provide an electronic notification of the dyad's responses to the care team to inform clinicians and connect the caregiver to resources as needed.

METHODS

We assessed usability and satisfaction with this patient-caregiver portal system among patients with cancer receiving palliative care, their caregivers, and clinicians.

RESULTS

Of 31 consented patient-caregiver dyads, 20 patients and 19 caregivers logged in. Further, 60% (n=12) of patients indicated a preference to communicate equally or together with their caregiver. Caregivers reported high emotional (n=9, 47.3%), financial (n=6, 31.6%), and physical (n=6, 31.6%) caregiving-related strain. The care team received all patient-caregiver responses electronically. Most patients (86.6%, 13/15 who completed the user experience interview) and caregivers (94%, 16/17 who completed the user experience interview) were satisfied with the system, while, of the 6 participating clinicians, 66.7% agreed "quite a bit" (n=1, 16.7%) or "very much" (n=3, 50%) that the system allowed them to provide better care.

CONCLUSIONS

Our findings demonstrate system usability, including a systematic way to identify caregiver needs and share with the care team in a way that is acceptable to patients and caregivers and perceived by clinicians to benefit clinical care. Integration of a patient-caregiver portal system may be an effective approach for systematically engaging caregivers. These findings highlight the need for additional research among caregivers of patients with less advanced cancer or with different illnesses.

Real-World Treatment Trends Among Patients with Metastatic Castration-Sensitive Prostate Cancer: Results from an International Study

BACKGROUND

Continuous androgen deprivation therapy ± first-generation non-steroidal antiandrogen was previously the standard-of-care for patients with metastatic castration-sensitive prostate cancer (mCSPC). Treatment intensification with novel hormonal therapy (NHT) or taxane chemotherapy is now approved and guideline-recommended for these patients.

METHODS

Physician-reported data on adult patients with mCSPC from the Adelphi Prostate Cancer Disease Specific Programme were analyzed descriptively. We evaluated real-world treatment trends for patients with mCSPC in 5 European countries (United Kingdom, France, Germany, Spain, and Italy) and the United States (US), looking at differences between patients initiating treatment in 2016-2018 and in 2019-2020. We also investigated treatment trends by ethnicity and insurance status in the US.

RESULTS

This study found that most patients with mCSPC do not receive treatment intensification. However, greater use of treatment intensification with NHT and taxane chemotherapy was observed in 2019-2020 than in 2016-2018 across 5 European countries. In the US, greater use of treatment intensification with NHT in 2019-2020 than in 2016-2018 was observed for all ethnicity groups and those with Medicare and commercial insurance status.

CONCLUSIONS

As the number of patients with mCSPC who receive treatment intensification increases, more patients who progress to metastatic castration-resistant prostate cancer (mCRPC) will have been exposed to intensified treatments. Treatment options for patients with mCSPC and mCRPC overlap, suggesting that an unmet need will emerge for new therapies. Further studies are needed to understand optimal treatment sequencing in mCSPC and mCRPC.

The role of the caregiver in older patients with advanced prostate cancer: results from the ADHERE Prospective Study of the Meet-URO network

PURPOSE

To assess caregivers' characteristics and influence of the presence or absence of the caregiver on clinical outcomes of older (≥70 years) metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone (ABI) or enzalutamide (ENZ).

METHODS

Patients from the Meet-URO 5 ADHERE study were assessed with a 5-item caregiver evaluation questionnaire focusing on the presence, age, degree of kinship, working status and qualification of the caregiver. We investigated the association between the presence of a caregiver and the clinical characteristics and outcomes of enrolled patients.

RESULTS

No differences were found in the main clinical characteristics between patients with or without a caregiver, except for a lower median G8 score (p = 0.0453) in the caregiver group. A longer radiographic PFS (rPFS) was observed in the group without a caregiver, with a trend towards more prolonged overall survival (OS) in the same group.

CONCLUSION

Our work suggests a detrimental effect of caregivers in managing older mCRPC patients treated with ABI or ENZ, especially those identified as frail by the geriatric G8 screening score. Further work is needed to identify and address patients' vulnerability areas, which could have a detrimental effect on prognosis.

Impact of Locus of Control on Patient-Provider Communication: A Systematic Review

Growing evidence shows there is heterogeneity in patient communication preferences and a need to tailor communication approaches accordingly. However, little is known about the psychosocial factors that influence communication preferences. Among them is locus of control (LOC), a belief about who or what determines outcomes, including health. Although LOC theory was developed over 60 years ago as a personality theory, its relevance in healthcare has increased over the past two decades. There is a paucity of empirical evidence on patient or provider LOC as it influences communication quality and outcomes in healthcare settings. We conducted a systematic review to collate the current state of the literature.We carried out a comprehensive search of PubMed MEDLINE, Embase, PsycInfo, and Cochrane Library databases to retrieve relevant peer-reviewed articles. A total of 1152 publications were identified. Our final review included 17 articles that underwent data extraction and quality assessment.The included studies found evidence of LOC associations with several patient and provider communication-related outcomes including satisfaction with care; medical decision-making and communication preferences; adherence; and patient-provider rapport. As opposed to generalized approaches to communication, assessing patient LOC may allow clinicians to tailor their approaches to match patients' LOC. Our findings provide a starting point and highlight the need for future studies.

Treatment decision-making among patients with metastatic prostate cancer: Impact of decision locus of control on functional outcomes and decision satisfaction

BACKGROUND

Shared decision-making (SDM) for metastatic prostate cancer (mPC) engages patients in the decision-making process and may be associated with better outcomes relative to physician- or patient-directed decision-making. We assessed the association between decision locus of control (DLOC) and patient-reported quality of life (QOL), functional outcomes, and decision satisfaction among mPC patients.

METHODS

After a clinic visit in which a treatment decision was made (baseline), mPC patients completed DLOC and QOL surveys. QOL was re-assessed at 2- and 4-months post-baseline. Mean scores for each QOL dimension (physical, emotional, cognitive, social, and role functioning) were compared by DLOC group using mixed effects models. Patient preferences for DLOC and provider communication techniques were similarly collected via survey.

RESULTS

Median age of participants (N = 101) was 69 years (range: 49-92); most were White (80%) and married (82%). 62% reported using SDM. At baseline, there were no differences in QOL dimensions between DLOC groups. At 4 months, patient-directed (p = 0.01) and SDM (p = 0.03) were associated with better physical functioning than physician-directed decision-making, and there was an indication of potentially greater decision satisfaction among patients who reported patient-directed (p = 0.06) or SDM (p = 0.10). SDM was the most reported preferred DLOC.

CONCLUSION

mPC patients reporting SDM had better physical functioning at 4 months than physician- or patient-directed decision-making, suggesting measurable benefit from patient involvement in decision-making. Future investigations of these associations in larger, more diverse populations can further clarify these previously unmeasured benefits of patient engagement in treatment decisions.