Strategies adopted by men to deal with uncertainty and anxiety when following an active surveillance/monitoring protocol for localised prostate cancer and implications for care

a longitudinal qualitative study embedded within the ProtecT trial

Julia Wade, Jenny Donovan, Athene Lane, Michael Davis, Eleanor Walsh, David Neal, Emma Turner, Richard Martin, Chris Metcalfe, Tim Peters, Freddie Hamdy, Roger Kockelbergh, James Catto, Alan Paul, Peter Holding, Derek Rosario, Howard Kynaston, Edward Rowe, Owen Hughes, Prasad Bollina & 4 others David Gillatt, Alan Doherty, Vincent J. Gnanapragasam, Edgar Paez

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Abstract

Objectives: Active surveillance (AS) enables men with low risk, localised prostate cancer (PCa) to avoid radical treatment unless progression occurs; lack of reliable AS protocols to determine progression leaves uncertainties for men and clinicians. This study investigated men's strategies for coping with the uncertainties of active monitoring (AM, a surveillance strategy within the Prostate testing for cancer and Treatment, ProtecT trial) over the longer term and implications for optimising supportive care. Design: Longitudinal serial in-depth qualitative interviews every 2-3 years for a median 7 (range 6-14) years following diagnosis. Setting: Four centres within the UK Protect trial. Participants: Purposive sample of 20 men with localised PCa: median age at diagnosis 64 years (range 52-68); 15 (75%) had low-risk PCa; 12 randomly allocated to, 8 choosing AM. Eleven men continued with AM throughout the study period (median 7 years). Nine received radical treatment after a median 4 years (range 0.8-13.8 years). Intervention: AM: 3-monthly serum prostate-specific antigen (PSA)-level assessment (year 1), 6-12 monthly thereafter; increase in PSA ≥50% during previous 12 months or patient/clinician concern triggered review. Main outcomes: Thematic analysis of 73 interviews identified strategies to accommodate uncertainty and anxiety of living with untreated cancer; implications for patient care. Results: Men sought clarity, control or reassurance, with contextual factors mediating individual responses. Trust in the clinical team was critical for men in balancing anxiety and facilitating successful management change/continued monitoring. Only men from ProtecT were included; men outside ProtecT may have different experiences. Conclusion: Men looked to clinicians for clarity, control and reassurance. Where provided, men felt comfortable continuing AM or having radical treatments when indicated. Clinicians build patient trust by clearly describing uncertainties, allowing patients control wherever possible and being aware of how context influences individual responses. Insights indicate need for supportive services to build trust and patient engagement over the long term. Trial registration number: ISRCTN20141297; Pre-results.

Original languageEnglish
Article numbere036024
Pages (from-to)1-11
Number of pages11
JournalBMJ Open
Volume10
Issue number9
DOIs
Publication statusPublished - 9 Sep 2020

Bibliographical note

Copyright the Author(s) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • prostate disease
  • qualitative research
  • urological tumours

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