Qualitative study on decision-making by prostate cancer physicians during active surveillance

Area of Science:

• Urology
• Oncology
• Health Services Research

Background:

• Active surveillance (AS) is a common strategy for managing low-risk prostate cancer.
• Physician decision-making in AS monitoring is complex and influenced by multiple factors.

Purpose of the Study:

• To identify and explore factors influencing physicians' decisions in monitoring prostate cancer patients undergoing active surveillance (AS).

Main Methods:

• Qualitative study involving 24 in-depth interviews with US physicians treating prostate cancer.
• Purposive sampling and Applied Thematic Analysis framework used for data collection and analysis.
• NVivo software and matrix analysis employed for organizing and analyzing interview transcripts.

Main Results:

• Eight key themes emerged: physician comfort with AS, protocol selection, beliefs about testing, experience, concerns about harm, patient characteristics, patient preferences, and financial incentives.
• Physician monitoring decisions reflect a balance between standardized protocols and individualized patient care.
• Variations in AS monitoring are explained by a combination of physician-centric and patient-centric factors.

Conclusions:

• Physician management of prostate cancer on AS is influenced by a range of factors, highlighting the need for standardized yet flexible approaches.
• Enhanced education on AS during urology training and continuing medical education is recommended.
• Further research is required to determine the comparative effectiveness of standardized versus individualized AS monitoring protocols.