Psychosocial barriers to active surveillance for the management of early prostate cancer and a strategy for increased acceptance
Psychosocial barriers to active surveillance for the management of early prostate cancer and a strategy for increased acceptance
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DOI：
10.1111/j.1464-410x.2007.06981.x
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发表时间：
2007-09-01
影响因子：
4.5
通讯作者：
Jakulj, Fabijana
中科院分区：
文献类型：
--
作者：
Pickles, Tom;Ruether, J. Dean;Jakulj, Fabijana
审查接受积极监测的男性的心理社会需求（AS，监测早期前列腺癌，只有在疾病显著进展时才进行治疗性干预），以及吸收前列腺癌的障碍，采用前列腺特异性抗原（PSA）筛查导致更多的男子被诊断患有早期和非危及生命的前列腺癌;大约一半的男性被诊断为PSA测试的结果，如果不进行治疗，他们的癌症将永远不会引起症状，但高达90%的男性接受治疗，然后生活在治疗的毒性中，但没有任何好处。因此，AS越来越多地被推广，但如果这样的战略是成功的，心理障碍，阻止男子采用AS必须加以解决。我们回顾和评估了自1994年以来发表的关于这一主题的英文报告。关于AS的研究相对较少，因为大多数已发表的报告都提到了观察等待（这是一种姑息治疗方法）。前列腺癌患者的心理障碍水平通常低于其他癌症患者，但确定的心理社会问题包括对无干预的焦虑，与失控有关的不确定性，以及缺乏患者教育和支持，特别是在最初的治疗计划期间。已确定的提高AS发病率的方法包括增加教育和改善沟通，减少焦虑和不确定性的干预措施，以及通过发展控制感和意义感来赋予患者权力。医生的态度是有影响力的，医生的教育作为一个适当的选择是值得鼓励的。同侪支持小组也被认为是特别有价值的，如果AS要被更广泛地采用，应该制定几项战略。增加教育和良好的沟通可以减轻焦虑和不确定性，认知重构的干预也可以。邀请病人成为他们管理的积极参与者可能会增强病人的控制感，同伴支持团体的参与可能是有益的。
To review the psychosocial needs of men undergoing active surveillance (AS, the monitoring of early prostate cancer, with curative intervention only if the disease significantly progresses) for prostate cancer, and barriers to its uptake.The introduction of screening for prostate-specific antigen (PSA) has led to more men diagnosed with early and nonlife-threatening forms of prostate cancer; about half of men diagnosed as a result of PSA testing have cancers that would never cause symptoms if left untreated and yet up to 90% of such men receive curative therapy, then living with the toxicity of treatment but with no benefit. Thus AS is increasingly being promoted, but if such a strategy is to succeed, the psychosocial barriers that discourage men from adopting AS must be addressed. We reviewed and assessed reports on this topic, published in English since 1994.There is relatively little research on AS, as most published reports refer to watchful waiting (which is a palliative management approach). Men with prostate cancer generally have lower levels of psychological disturbance than for other cancers, but the psychosocial issues identified include anxiety in response to no intervention, uncertainty related to loss of control, and lack of patient education and support, particularly around the time of initial treatment planning. Approaches that were identified to improve uptake of AS include increased education and improved communication, interventions to reduce anxiety and uncertainty, and the empowerment of patients by the development of a sense of control and meaning. Physicians attitudes are influential and the education of physicians about AS as an appropriate option is to be encouraged. Peer-support groups were also identified as being of particular value.There are several strategies that should be developed if AS is to become more widely adopted. Increased education and good communication can alleviate anxiety and uncertainty, as can interventions for cognitive re-framing. Inviting patients to become active participants in their management might enhance the patients' sense of control, and the involvement of peer-support groups might be beneficial.