Decision-Making Dilemmas Among Elderly Prostate Cancer Patients Receiving ¹⁷⁷Lu-PSMA Therapy: A Qualitative Study

To explore the decision-making dilemmas experienced by elderly patients with advanced prostate cancer when considering ¹⁷⁷Lu-PSMA therapy, and to provide evidence for the development of tailored decision-support strategies.

A qualitative descriptive design was adopted. Using purposive sampling, 20 elderly prostate cancer patients who had received ¹⁷⁷Lu-PSMA therapy at a tertiary hospital in China between April and June 2025 were recruited for semi-structured interviews. Data were analyzed following Braun's style of thematic analysis.

Three overarching themes and nine subthemes were identified, reflecting multi-layered decision-making conflicts. (1) Decision-making triggers dilemma described information cognitive deficits, family value conflicts, and weak support systems that constrained patients' understanding and autonomy. (2) Decision-conflicting perceptual dilemma captured uncertainty regarding treatment efficacy and emotional distress caused by disease progression and prior treatment experiences. (3) Coping-adaptive behavioral dilemma illustrated financial constraints, dependent decision tendencies, and varied coping strategies, alongside expressed needs for accessible and technology-supported tools. These findings reveal the complex interplay of cognitive, emotional, familial, and systemic factors influencing treatment decisions.

Effective resource support can help elderly prostate cancer patients cope with various dilemmas during the ¹⁷⁷Lu-PSMA treatment decision-making process. Nursing staff should address the actual needs of patients, explore the clinical application of emerging age-appropriate decision-support interventions, and construct decision-support programs tailored to patient characteristics, thereby helping patients develop positive coping mechanisms and enhancing their active participation as well as rational decision-making abilities.