The Functions of Affect in Treatment Decisions of Rising PSA Patients

描述（由申请人提供）：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接受过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水平升高。经历PSA升高或生化失败的患者（约60，000例患者/年）不仅要处理癌症复发的可能性，还要处理治疗决策，特别是是否以及何时应该开始治疗以及选择何种治疗。所有治疗（观察除外）都有明显的副作用，并会影响生活质量。在这种情况下，做决定是困难的。使用认知情感的自我调节框架，我们专注于影响和认知的决策PSA水平的上升。具体而言，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）作为用于突出特定信息的聚光灯的情感;以及c）作为行动动机的情感。第二个目标是将情感功能的研究结果整合到更大的理论自我调节框架中。我们将使用定量数据评估和定性深入访谈组成的混合方法，收集N = 168例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，而定性方法则旨在发现患者赋予疾病及其治疗方案的意义。将在基线时评估问卷数据，并在12个月内评估4次。将对决定选择积极治疗的患者和研究期结束时选择继续观察等待的患者（即，维持现状）。治疗后，在探索性的基础上对患者进行随访，以评估决策冲突和生活质量。我们假设癌症特定的负面影响会影响风险认知;对治疗或观察的积极情感反应会导致对治疗方案利弊的差异评价;负面影响会预测治疗而不是观察。我们将使用回归分析来评估情感功能的预测能力，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，这项研究的结果将有助于我们理解患者实际上是如何做出决定的（描述性模型）。此外，我们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，研究结果的整合将推进自我调节理论，并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.