The Functions of Affect in Treatment Decisions of Rising PSA Patients

描述(申请人提供)：前列腺特异性抗原(PSA)检测的广泛使用使医生能够密切监测曾接受前列腺癌治疗的患者。这导致在没有疾病临床证据的前列腺癌幸存者中检测到PSA水平上升。PSA升高或生化衰竭的患者(每年约60,000名患者)不仅要处理癌症复发的可能性，还要处理治疗决定，特别是是否以及何时应该开始治疗以及选择何种治疗。所有的治疗(除观察外)都有明显的副作用，并将影响生活质量。在这种情况下做出决策充其量也是困难的。使用认知-情感自我调节框架，我们关注情绪和认知对PSA水平上升时决策的影响。具体地说，本应用程序的主要目标是探索决策中三种情感功能的存在和影响：a)作为信息的情感；b)作为聚光灯用于突出特定信息的情感；以及c)作为行动动力的情感。第二个目标是将关于情感功能的研究结果整合到更大的理论自我调节框架中。我们将使用由定量数据评估和定性深度访谈组成的混合方法来收集N=168名被诊断为生化失败的患者的数据。定量数据评估的目标是发现决策过程的结构，而定性方法的目的是发现患者赋予疾病及其治疗选择的意义。问卷数据将在基线上进行评估，并在12个月内进行4次评估。将对那些决定选择积极治疗的患者以及在研究结束时选择继续观察等待(即保持现状)的患者进行深入的面对面访谈。治疗后，在探索性的基础上，对决策患者进行跟踪，以评估决策冲突和生活质量。我们假设癌症特有的负面情绪将影响风险认知；对治疗或观察的积极情绪反应将导致对治疗方案利弊的不同评估；负面情绪将预测治疗而不是观察。我们将使用回归分析来评估情感函数的预测能力，并使用定性数据方法来说明情感在决策中的作用。在实践层面上，这项研究的发现将有助于我们理解患者实际上是如何做出决定的(一个描述性模型)。此外，我们还将探讨这与理想的决策过程(规范模型)有何不同，以及如何改进这一过程(规范模型)。在理论层面上，这些发现的整合将推动自我调节理论的发展，并总体上为决策和健康行为选择提供信息。

DESCRIPTION (provided by applicant): The widespread use of prostate-specific antigen (PSA) testing has enabled physicians to closely monitor patients who have been treated for prostate cancer. This has resulted in the detection of rising PSA levels among prostate cancer survivors without clinical evidence of disease. Patients who experience a rising PSA or biochemical failure (circa 60,000 patients/year) have to deal not only with the possibility of a cancer recurrence, but also with treatment decisions, specifically, if and when treatment should be started and what kind of treatment to choose. All treatments (except for observation) have significant side-effects and will influence quality of life. Decision making in such circumstances is difficult at best. Using a cognitive-affective self-regulation framework we are focusing on the influence of affect and cognition on decision making for a rising PSA level. Specifically, the primary goal of this application is to explore the existence and influence of three affect functions in decision making: a) affect as information; b) affect as a spotlight used to highlight specific information; and c) affect as a motivator for action. A second objective is to integrate findings on affect functions into the larger theoretical self-regulation framework. We will use a mixed-methods approach consisting of quantitative data assessments and qualitative in-depth interviews to collect data on N = 168 patients diagnosed with biochemical failure. The goal of the quantitative data assessment is to discover the structure of the decision making process, while the qualitative approach is directed toward discovering meaning the patient assigns to the disease and its treatment options. Questionnaire data will be assessed at baseline and 4 times over a 12 months period. In-depth, in-person interviews will be conducted among those patients who have made a decision to opt for active treatment and among those patients who at the end of the study period opt to continue with watchful waiting (i.e., maintain the status quo). Post treatment, decision patients are followed, on an exploratory basis, to assess decisional conflict and quality of life. We hypothesize that cancer specific negative affect will influence risk perceptions; that a positive affective response to treatment or observation will lead to differential evaluation of pros and cons of a treatment option; and that negative affect will predict treatment over observation. We will use regression analyses to evaluate the predictive power of affect functions and qualitative data approaches to illustrate the role of affect in decision making. On a practical level, findings from this research will contribute to our understanding of how patients actually make decisions (a descriptive model). In addition, we will explore how this differs from an ideal decision making process (a normative model), and how this process might be improved (a prescriptive model). On a theoretical level, the integration of findings will advance self-regulation theory and inform decision making and health behavior choice in general.