Qualitative study on decision-making by prostate cancer physicians during active surveillance.
To explore and identify factors that influence physicians' decisions while monitoring patients with prostate cancer on active surveillance (AS).



A purposive sampling strategy was used to identify physicians treating prostate cancer from diverse clinical backgrounds and geographic areas across the USA. We conducted 24 in-depth interviews from July to December 2015, until thematic saturation was reached. The Applied Thematic Analysis framework was used to guide data collection and analysis. Interview transcripts were reviewed and coded independently by two researchers. Matrix analysis and NVivo software were used for organization and further analysis.



Eight key themes emerged to explain variation in AS monitoring: (i) physician comfort with AS; (ii) protocol selection; (iii) beliefs about the utility and quality of testing; (iv) years of experience and exposure to AS during training; (v) concerns about inflicting 'harm'; (vi) patient characteristics; (vii) patient preferences; and (viii) financial incentives.



These qualitative data reveal which factors influence physicians who manage patients on AS. There is tension between providing standardized care while also considering individual patients' needs and health status. Additional education on AS is needed during urology training and continuing medical education. Future research is needed to empirically understand whether any specific protocol is superior to tailored, individualized care.
Department of Urology, New York University, New York, NY, USA.|Department of Population Health, New York University, New York, NY, USA.|Laura and Isaac Perlmutter Cancer Center, New York University, New York, NY, USA.|Manhattan Veterans Affairs Medical Center, New York University, New York, NY, USA.
Stacy
S
Loeb
Department of Population Health, New York University, New York, NY, USA.
Caitlin
C
Curnyn
Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.|Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, Salt Lake City VA, UT, USA.
Angela
A
Fagerlin
Department of Population Health, New York University, New York, NY, USA.
Ronald Scott
RS
Braithwaite
Department of Population Health, New York University, New York, NY, USA.|Manhattan Veterans Affairs Medical Center, New York University, New York, NY, USA.
Mark D
MD
Schwartz
Department of Urology, New York University, New York, NY, USA.|Laura and Isaac Perlmutter Cancer Center, New York University, New York, NY, USA.
Herbert
H
Lepor
Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Herbert Ballentine
HB
Carter
Department of Population Health, New York University, New York, NY, USA.
Erica
E
Sedlander
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D010817:Physician-Patient Relations; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D036301:Qualitative Research; D014481:United States; D057832:Watchful Waiting
active surveillance; markers; prostate cancer; qualitative; survey