Deciding About Prostate Cancer Treatment: Role of Race, Literacy, Anxiety, and Doctor Recommendation.

Fagerlin A. Deciding About Prostate Cancer Treatment: Role of Race, Literacy, Anxiety, and Doctor Recommendation. Poster session presented at: American Psychological Association Annual Convention; 2013 Jul 31; Honolulu, HI.

Purpose: Men who are diagnosed with early stage prostate cancer have four treatment options available to them: surgery, external beam radiation, brachytherapy, and active surveillance. Research has shown the treatments to be equivalent in terms of 10 year all cause mortality rate, but the rates of side effects are different across the treatments. Thus, men must make difficult decisions regarding which treatment to undergo. The purpose of the current study was to determine factors that influenced patients' treatment decisions over time. Methods: 1015 men were recruited from 4 VA hospitals (Ann Arbor, Durham, Pittsburgh, San Francisco) immediately after receiving a prostate biopsy because of suspicion of prostate cancer. Men received an education intervention and completed surveys at three time periods: at their biopsy (Time 1), immediately before receiving their cancer diagnosis (Time 2), and one week following diagnosis (Time 3). Only those patients with a positive biopsy result indicating localized prostate cancer (PSA < 20, Gleason score of 6-7) were eligible to complete Time 2 and 3 surveys (N = 335). Primary dependent variables included preference for treatment at Times 2 and 3 and treatment received. Independent variables included race (White vs. Black), literacy level (REALM), anxiety (MAX-PC), knowledge, interest in participation in decision making, and patient's perception of their physician's recommendation. Results: White patients were more likely to prefer watchful waiting than surgery at Time 2 (just prior to talking with their physician) than were African American patients (X2 = 24.77, p < 0.02). Patients with inadequate literacy levels were more likely to prefer surgery over watchful waiting at Time 2,whereas those patients with adequate literacy showed the reverse pattern (X2 = 12.98, p < 0.05). Patients with lower anxiety were significantly more likely to undergo watchful waiting than other treatments, whereas those with higher anxiety were equally split between surgery and watchful waiting (X2 = 6.78, p < 0.05). Neither race or literacy level were related to treatment preference after talking with their physician or the treatment that patients received. Additionally, patient's knowledge, perception of their communication with their physician, their interest in participating in the decision making also did not predict the treatment they actually received (all p's > 0.10). Instead, the only factor that predicted treatment was the patient's perception of their physician's treatment recommendation and the patient's anxiety (p's < 0.05). Conclusions: Patients' treatment preferences before they saw their urologist differed based on the race and literacy level. However, once physicians offered their recommendations, patients' preferences were only influenced by that recommendation and their level of anxiety. Other factors that you would expect to influence the patients' treatment decision (knowledge, interest in shared decision making) did not predict patients' treatment preferences. These results suggest that physician's recommendations and anxiety may be very powerful drivers in patients' prostate cancer treatment decision making.