Strategies adopted by men to deal with uncertainty and anxiety when following an active surveillance/monitoring protocol for localised prostate cancer and implications for care: a longitudinal qualitative study embedded within the ProtecT trial

Julia Wade*, Jenny L Donovan , J. Athene Lane, Michael J Davis, Eleanor I Walsh, David Neal, Emma L Turner, Richard M Martin, Chris Metcalfe, TJ Peters, Freddie C. Hamdy, Roger Kockelbergh, James Catto, Alan Paul, Peter Holding, Derek J. Rosario, Howard Kynaston, Edward Rowe, Owen Hughes, Prasad BollinaDavid A Gillatt, Alan Doherty, Vincent J. Gnanapragasam, Edgar Paez

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)
14 Downloads (Pure)

Abstract

Objectives
Active surveillance (AS) enables men with low risk, localised prostate cancer (PCa) to avoid radical treatment unless progression occurs; lack of reliable AS protocols to determine progression leaves uncertainties for men and clinicians. This study investigated men’s strategies for coping with the uncertainties of active monitoring (AM, a surveillance strategy within the Prostate testing for cancer and Treatment, ProtecT trial) over the longer term and implications for optimising supportive care.

Design
Longitudinal serial in-depth qualitative interviews every 2–3 years for a median 7 (range 6–14) years following diagnosis.

Setting
Four centres within the UK Protect trial.

Participants
Purposive sample of 20 men with localised PCa: median age at diagnosis 64 years (range 52–68); 15 (75%) had low-risk PCa; 12 randomly allocated to, 8 choosing AM. Eleven men continued with AM throughout the study period (median 7 years). Nine received radical treatment after a median 4 years (range 0.8–13.8 years).

Intervention
AM: 3-monthly serum prostate-specific antigen (PSA)-level assessment (year 1), 6–12 monthly thereafter; increase in PSA ≥50% during previous 12 months or patient/clinician concern triggered review.

Main outcomes
Thematic analysis of 73 interviews identified strategies to accommodate uncertainty and anxiety of living with untreated cancer; implications for patient care.

Results
Men sought clarity, control or reassurance, with contextual factors mediating individual responses. Trust in the clinical team was critical for men in balancing anxiety and facilitating successful management change/continued monitoring. Only men from ProtecT were included; men outside ProtecT may have different experiences.

Conclusion
Men looked to clinicians for clarity, control and reassurance. Where provided, men felt comfortable continuing AM or having radical treatments when indicated. Clinicians build patient trust by clearly describing uncertainties, allowing patients control wherever possible and being aware of how context influences individual responses. Insights indicate need for supportive services to build trust and patient engagement over the long term.
Original languageEnglish
Article numbere036024
Number of pages11
JournalBMJ Open
Volume10
Issue number9
DOIs
Publication statusPublished - 9 Sep 2020

Bibliographical note

The acceptance date for this record is provisional and based upon the month of publication for the article.

Keywords

  • prostate disease
  • Urology
  • qualitative research
  • urological tumours

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