Who makes the decision regarding the treatment of clinically localized prostate cancer--the patient or physician?: results from a population-based study.
BACKGROUND
The current study examined how patients' sociodemographic, cancer-related, and subjective affective factors impacted their role in treatment decision-making.


METHODS
The patient sample (N = 788) was taken from a prospective follow-up study of a population-based cohort. Participants included 343 African American and 445 Caucasian-American patients with clinically localized prostate cancer. Multinomial logistic regression was used to investigate relations between the explanatory variables and the nominal 3-level decision-making variable: patient-only, patient-physician shared, and physician-only.


RESULTS
Approximately 41% of patients reported patient-only decision-making, 45% reported shared decision-making, and 13% reported physician-only decision-making. The odds of patient-only over physician-only decision-making were greater for younger men (vs those aged ≥ 65 years) (odds ratio [OR], 1.68; 95% confidence interval [95% CI], 1.03-2.74), and were less for men with high (vs low) cancer aggressiveness (OR,0.29; 95% CI, 0.15-0.55). The odds of shared over physician-only decision-making were less for men with high (vs low) cancer aggressiveness (OR, 0.40; 95% CI, 0.22-0.73). Greater odds of patient-only and shared decision-making also were found to be associated with greater concerns about the physical impact of treatment and having enough time for decision-making and lower scores of receiving advice from others.


CONCLUSIONS
The findings of the current study indicate that, to facilitate a more patient-oriented decision-making process regarding treatment in those with clinically localized prostate cancer, clinicians need to tailor their interventions according to patient age and cancer aggressiveness, help reduce patient concerns and misconceptions regarding the physical impact of treatments, allow sufficient time for patients to consider treatment options, and assist patients in balancing advice and information received from different sources.
Adult and Geriatric Health Division, School of Nursing, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7460, USA. lsong@unc.edu
Lixin
L
Song
Ronald C
RC
Chen
Jeannette T
JT
Bensen
George J
GJ
Knafl
Matthew E
ME
Nielsen
Laura
L
Farnan
Eric M
EM
Wallen
Merle
M
Mishel
Raj S
RS
Pruthi
James L
JL
Mohler
Paul A
PA
Godley
D000368:Aged; D003657:Decision Making; D019468:Disease Management; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010819:Physician's Role; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000628:therapy*