Decision Making For Active Surveillance in Prostate Cancer Patients and Spouses

描述（由申请人提供）：前列腺癌是美国男性最常见的癌症部位，2011年有超过24万男性被诊断患有前列腺癌。在过去的几年里，广泛的前列腺特异性抗原（PSA）筛查导致这些癌症的早期发现。筛查也引起了争议，因为患有非常早期疾病的男性在接受治疗时，尚不清楚治疗在多大程度上可能对他们有益。许多临床医生一致认为，早期前列腺癌正在被过度治疗，据估计，27-56%接受早期前列腺癌治疗的男性可以通过主动监测（AS）得到有效管理。鉴于与治疗相关的潜在重大副作用（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。医生已经注意到，心理因素，如焦虑或某些疾病和治疗相关的信念可能会影响男性和他们的伴侣选择积极治疗（AT）而不是as。此外，亲密伴侣作为癌症患者的主要社会支持，往往对治疗选择产生重要影响。这些轶事观察得到理论（即，自我调节理论）和文献报告的支持。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。本研究旨在以认知、情感和社会/伴侣因素为研究对象，运用理论指导的自我调节方法来研究自闭症患者的决策过程。这将是第一次全面审查的贡献

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.