Appraising risk in active surveillance of localized prostate cancer
Objectives: Men diagnosed with low‐risk prostate cancer are typically eligible for active surveillance of their cancer, involving monitoring for cancer progression and making judgements about the risks of prostate cancer against those of active inter‐ vention. Our study examined how risk for prostate cancer is perceived and expe‐ rienced by patients undergoing active surveillance with their clinicians, how risk is communicated in clinical consultations, and the implications for treatment and care.
Method: Participants were nine patients and three clinicians from a university hos‐ pital urology clinic. A staged, qualitative, multi‐method data collection approach was undertaken, comprising: observations of consultations; patient and clinician in‐ terviews; and patient surveys. The three data sets were analysed separately using thematic analysis and then integrated to give a comprehensive view of patient and clinician views.
Results: Thirty data points (eight patient surveys; 10 observations of consultations between patients and clinicians; 10 patient interviews; and two clinician interviews) combined to create a detailed picture of how patients perceived and appraised risk, in three themes of “Making sense of risk”, “Talking about risk” and “Responding to risk”.
Conclusion: Effective risk communication needs to be finely tuned and timed to in‐ dividual patient's priorities and information requirements. A structured information exchange process that identifies patients’ priorities, and details key moments in risk assessment, so that complexities of risk are discussed in ways that are meaningful to patients, may benefit patient care. These findings could inform the development of patient‐centric risk assessment procedures and service delivery models in prostate cancer care more broadly.
History
Publication title
Health ExpectationsVolume
22Issue
5Pagination
1028-1039ISSN
1369-6513Department/School
Australian Institute of Health Service Management (AIHSM)Publisher
WileyPlace of publication
United KingdomRights statement
© 2019 The Authors Health Expectations published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0/Repository Status
- Open