scholarly journals Factors that influence clinicians’ decisions to decrease active surveillance monitoring frequency or transition to watchful waiting for localised prostate cancer: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e048347
Author(s):  
Lisa M Lowenstein ◽  
Noah J Choi ◽  
Karen E Hoffman ◽  
Robert J Volk ◽  
Stacy Loeb
Keyword(s):  
Prostate Cancer ◽  
Qualitative Study ◽  
Active Surveillance ◽  
Watchful Waiting ◽  
Clinical Care ◽  
Legal Issue ◽  
Dominant Factor ◽  
Structured Interviews ◽  
Framework Analysis ◽  
The Usa

ObjectiveLittle is known about clinicians’ decision-making about decreasing active surveillance (AS) testing/converting patients to watchful waiting (WW), nor are there any guidelines. The objective of this study was to identify factors that clinicians consider when decreasing AS testing/converting to WW for men with prostate cancer.DesignExploratory qualitative study.SettingAll participants practiced in various institutions in the USA.ParticipantsEligible clinicians had to provide clinical care for patients with prostate cancer in the USA and speak English. Clinicians could be either urologists or radiation oncologists. Of the 24 clinicians, 83% were urologists representing 11 states, 92% were men and 62% were white.MethodsThis qualitative study used data from semi-structured interviews. Purposive sampling was used to ensure geographical variation in the USA. Data collection continued until thematic saturation was achieved. Framework analysis guided coding and identification of themes. Two researchers coded all transcripts independently, met to discuss and reached consensus.ResultsInterviews with clinicians demonstrated that testing or monitoring for AS or transitioning to WW is happening in practice, whether intentionally or unintentionally. Decisions to decrease AS were personalised and tailored to patients’ health status. Life expectancy was the dominant factor that influenced decision, but clinicians were generally hesitant to specify an age when they would decrease AS or transition to WW. Fear that poor adherence could lead to missed progression and concerns about the medico-legal issue of not doing enough were cited as barriers to decreasing AS.ConclusionsThese findings suggest that in certain situations, AS frequency is reduced or transitioned to WW, yet decisions appear to be inconsistent and there are no significant barriers. These findings could inform further areas to explore when drafting recommendations that consider patients’ values and preferences when making decisions about decreasing AS/converting to WW.

scholarly journals Perceptions of partial gland ablation for prostate cancer among men on active surveillance: a qualitative study

2021 ◽  
Vol 3 (1) ◽  
pp. e000068
Author(s):  
Sonia Hur ◽  
Michael Tzeng ◽  
Eliza Cricco-Lizza ◽  
Spyridon Basourakos ◽  
Miko Yu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Qualitative Study ◽  
Active Surveillance ◽  
Treatment Modality ◽  
Tertiary Care ◽  
Low Risk ◽  
Intermediate Risk ◽  
Perceptions And Attitudes ◽  
Partial Gland Ablation

ObjectivesPartial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy-proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS).Design92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semistructured telephone interviews on PGA.SettingSingle tertiary care center located in New York City.Participants20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews.Main outcome measuresEmerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology.ResultsFour themes were derived from 20 interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while nine men (45%) expressed interest at the current moment.ConclusionsAlthough an emerging treatment modality, patients were broadly accepting of PGA for PCa, with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men’s preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.

Using Competing Risk of Mortality to Inform the Transition from Prostate Cancer Active Surveillance to Watchful Waiting

2021 ◽  
Author(s):  
Mitchell M. Huang ◽  
Ridwan Alam ◽  
Andrew T. Gabrielson ◽  
Zhuo T. Su ◽  
Borna Kassiri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Watchful Waiting ◽  
Competing Risk ◽  
Risk Of Mortality

scholarly journals Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions

2017 ◽  
Vol 72 (6) ◽  
pp. 899-907 ◽  
Author(s):  
Stacy Loeb ◽  
Qinlian Zhou ◽  
Uwe Siebert ◽  
Ursula Rochau ◽  
Beate Jahn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Watchful Waiting ◽  
Localized Prostate Cancer

Long-term Psychological and Quality-of-life Effects of Active Surveillance and Watchful Waiting After Diagnosis of Low-risk Localised Prostate Cancer

2018 ◽  
Vol 73 (6) ◽  
pp. 859-867 ◽  
Author(s):  
Sam J. Egger ◽  
Ross J. Calopedos ◽  
Dianne L. O’Connell ◽  
Suzanne K. Chambers ◽  
Henry H. Woo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Active Surveillance ◽  
Watchful Waiting ◽  
Low Risk

scholarly journals Knowledge Translation Improvement Strategies in Universities of Medical Sciences in Iran: A Qualitative Study

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Sogand Tourani ◽  
Narges Rafiei ◽  
Shahnaz Rimaz ◽  
Seyed Kazem Malakouti ◽  
Alireza Heidari
Keyword(s):  
Qualitative Study ◽  
Knowledge Translation ◽  
Knowledge Production ◽  
Data Organization ◽  
Health Plans ◽  
Medical Sciences ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Improvement Strategies

BACKGROUND፡ Recently, one of the challenges in the health system of the country is the need for research contributing to policy-making. Therefore, it is crucial to develop activities in the field of knowledge Translation (KT). This study aimed to propose KT improvement strategies in universities of medical sciences in Iran.METHODS: In this qualitative study, 18 semi-structured interviews were conducted with key informants from the medical universities in Iran during January-July 2018. The transcribed documents were analyzed using the Gale framework analysis approach. Data organization was carried out using MAXQDA version 10 software.RESULTS: According to framework analysis, six KT improvement strategies were identified including improving the abilities and skills of researchers, improving the processes and quality of knowledge production, revising policies and laws, mproving the prerequisites, culture-building, and promoting the, use of evidence.CONCLUSION: Given the challenges and strategies outlined in this study, it seems that the mechanism of KT and its effects on improving health plans for policymakers and researchers has not been elucidated yet. Therefore, considerable changes in prerequisites, knowledge production processes, academic procedures, policies and laws are necessary for implementing KT in universities of medical sciences in Iran. 

scholarly journals Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

2020 ◽  
pp. 1-15
Author(s):  
Gary Lamph ◽  
John Baker ◽  
Tommy Dickinson ◽  
Karina Lovell
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Personality Disorder ◽  
Qualitative Study ◽  
Patient Group ◽  
Stepped Care ◽  
Research Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Co Morbidity

Abstract Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.

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