Decision Making For Active Surveillance in Prostate Cancer Patients and Spouses

描述(申请人提供)：前列腺癌是美国男性最常见的癌症部位，2011年有超过24万男性被诊断为前列腺癌。在过去的几年里，广泛的前列腺特异性抗原(PSA)筛查导致了这些癌症的早期发现。筛查也引发了争议，因为患有早期疾病的男性正在接受治疗，但目前尚不清楚治疗对他们的益处有多大。许多临床医生一致认为，早期疾病被过度治疗，据估计，27%-56%的接受早期前列腺癌治疗的男性可以通过积极的监测(AS)得到有效控制。考虑到与治疗相关的潜在严重副作用(例如，勃起功能障碍、尿失禁和肠道刺激)，AS是低级别疾病患者的重要和可行的替代方案。医生们已经注意到，焦虑或某些疾病以及与治疗相关的信念等心理因素可能正在影响男性及其伴侣选择积极治疗(AT)而不是AS。此外，亲密伴侣往往对治疗选择产生重要影响，因为他们是癌症患者的主要社会支持。这些轶事观察得到了理论(即自我调节理论)和文献中报告的支持。然而，缺乏对这些认知-情感和社会因素对决定和坚持AS方案的影响的系统检查。本申请旨在使用理论指导的自我调节方法调查AS的决策过程，重点关注认知、情感和社会/伴侣因素。这将是第一次全面审查 情感和认知过程对AS决策的影响。这也将是这篇文献中第一次通过使用定性和定量的数据收集方法来包括患者伴侣对决策的看法。因此，本研究的具体目标是：1)探索符合积极监测条件的前列腺癌患者及其伴侣/亲密盟友的认知和情感治疗决策过程。目的2：解释患者是如何做出决定的，并调查伴侣/亲密盟友在这一过程中所起的影响。 公共卫生相关性：前列腺癌是美国男性最常见的癌症部位，2011年有超过24万男性被诊断为前列腺癌。在过去的几年里，广泛的前列腺特异性抗原(PSA)筛查导致了这些癌症的早期发现。筛查也引发了争议，因为患有早期疾病的男性正在接受治疗，但目前尚不清楚治疗对他们的益处有多大。许多临床医生一致认为，早期疾病被过度治疗，据估计，27%-56%的接受早期前列腺癌治疗的男性可以通过积极的监测(AS)得到有效控制。考虑到与治疗相关的潜在严重副作用(例如，勃起功能障碍、尿失禁和肠道刺激)，AS是低级别疾病患者的重要和可行的替代方案。本研究将探讨符合强直性脊柱炎患者的情感和认知决策过程。

DESCRIPTION (provided by applicant): Prostate cancer is the most common site of cancer in men in the United States with over 240,000 men diagnosed with prostate cancer in 2011. Over the past years, widespread prostate specific antigen (PSA) screening has resulted in the earlier detection of these cancers. Screening has also led to controversy as men with very early stage disease are being treated when it is not clear to what extent treatment may be of benefit to them. Many clinicians agree that early stage disease is being over treated and it is estimated that 27-56% of men who undergo treatment for early stage prostate cancer can be managed effectively with active surveillance (AS). Given the potential for significant side-effects (e.g., erectile dysfunction, urinary incontinence, and bowl irritation) associated with treatment, AS is an important and viable alternative for patients with low-grade disease. Physicians have noticed that psychological factors such as anxiety or certain disease and treatment related beliefs may be influencing men and their partners to select active treatment (AT) over AS. In addition, intimate partners often exert an important influence of treatment choice as they are the primary social support for cancer patients. These anecdotal observations are supported by theory (i.e., self- regulation theory) and reports in the literature. However, a systematic examination of the influence of these cognitive-affective and social factors on the decision to decide on and adhere to an AS regimen is missing. The present application aims to investigate the decision making process for AS using a theory-guided self- regulation approach focusing on cognitive, affective and social/partner factors. This will be the first comprehensive examination of the contribution of affective and cognitive processes to decision making for AS. It will also be the first in this literature to include the perspective of patients' partners on decision making through the use of qualitative and quantitative data collection methods. Thus, the specific aims are: 1) to explore the cognitive and affective treatment decision-making processes among prostate cancer patients who are eligible for active surveillance and their partners/close allies. Aim 2: To explor how patients arrived at their decision and to investigate the influence partners/close allies play in this process. PUBLIC HEALTH RELEVANCE: Prostate cancer is the most common site of cancer in men in the United States with over 240,000 men diagnosed with prostate cancer in 2011. Over the past years, widespread prostate specific antigen (PSA) screening has resulted in the earlier detection of these cancers. Screening has also led to controversy as men with very early stage disease are being treated when it is not clear to what extent treatment may be of benefit to them. Many clinicians agree that early stage disease is being over treated and it is estimated that 27-56% of men who undergo treatment for early stage prostate cancer can be managed effectively with active surveillance (AS). Given the potential for significant side-effects (e.g., erectile dysfunction, urinary incontinence, and bowl irritation) associated with treatment, AS is an important and viable alternative for patients with low-grade disease. This study will explore the affective and cognitive decision making processes in men eligible for AS.