Decisional regret and quality of life after participating in medical decision‐making for early‐stage prostate cancer

• Published in: BJU international Vol. 91; no. 1; pp. 14 - 17
• Main Authors: Davison, B.J., Goldenberg, S.L.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-01-2003; Blackwell
• Subjects: Adult; Aged; Antineoplastic Agents, Hormonal - therapeutic use; Biological and medical sciences; Chemotherapy, Adjuvant; Decision Making; decisional regret; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Patient Participation; prostate cancer; Prostatectomy - methods; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - surgery; Quality of Life; Surveys and Questionnaires; Tumors of the urinary system; Urinary tract. Prostate gland; Human; Adenocarcinoma; decisional regret; Urinary system disease; Prostate disease; Male; Early stage; Malignant tumor; Quality of life; prostate cancer; Physician patient relation; Treatment; decision-making; Adult; Evolution; Male genital diseases; Prostate
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1046/j.1464-410X.2003.04005.x

OBJECTIVE
To determine the effect of men's reported levels of involvement in medical decision‐making and quality of life (QoL) on their levels of decisional regret after definitive treatment.
PATIENTS AND METHODS
Men referred to a hospital‐based resource centre completed QoL and decisional‐regret measures after definitive treatment for localized prostate cancer. Data from these questionnaires were linked with a previous study conducted to determine if providing individualized information to men newly diagnosed with prostate cancer would lower their levels of psychological distress and enable them to become more active participants in treatment decision‐making. The preferred role in medical decision‐making and QoL had previously been measured at the time of diagnosis and the assumed role at 4 months after the definitive treatment decision. This postal survey was conducted ≈ 18 months after diagnosis.
RESULTS
Of 74 men, 67 (91%) responded; the mean (sd) time since definitive treatment was 10.3 (4.7) months and the mean age of the men 62.5 (6.9) years. Radical prostatectomy was the most frequent treatment (72%). Most (94%) patients participated in medical decision‐making either actively or collaboratively and did not regret their treatment choice. The type of definitive treatment received had no effect on decisional regret; patients’ QoL scores were similar to the levels before treatment. Levels of sexual function were significantly lower after definitive treatment, but urinary incontinence was not significantly affected. Men who had neoadjuvant hormone therapy reported having significantly more treatment‐related symptoms.
CONCLUSIONS
There is no evidence that providing information to facilitate participation in medical decision‐making causes decisional regret or psychological distress within the first year after definitive treatment. A longitudinal follow‐up of these patients is required to adequately assess the long‐term effects of treatment on QoL and decisional regret.