Purpose: In a study of men undergoing biopsy and treatment for prostate cancer, we examined whether pre-existing Cancer Anxiety and preferences for active medical interventions (Action Bias) influence treatment preferences and decisions. We used an established measure of Anxiety and a new measure of Action Bias to explore how these pre-existing individual differences impact decisions at different points in the decision-making process.
Method: 1015 men, with suspicion of prostate cancer, were recruited from 4 VA hospitals at the time of biopsy, as a part of a study of prostate cancer decision aids (DA). Prior to reading a DA, patients completed a questionnaire that assessed their prostate cancer anxiety (Memorial Anxiety Scale for Prostate Cancer), and their bias toward active treatment options (e.g. “Doing everything to fight cancer is the right choice”). These baseline measures were used to predict (1) treatment preferences expressed after reading the DA, but prior to diagnosis, (2) treatment decisions following the urologist visit for diagnosis, and (3) treatment receivedaccording to medical records.
Result: For preferences expressed prior to diagnosis, patients who preferred surgery had greater pre-existing Action Bias than those who did not (M=6.40 vs. 6.02, p<.01) and patients who preferred active surveillance had less Action Bias than those who did not (M=5.85 vs. 6.34, p<.01). Anxiety was not predictive. Later, after prostate cancer was diagnosed, both Action Bias and Anxiety predicted treatment decisions among patients who had definitively decided upon a course of action: Those who selected active surveillance had less Action Bias (M=5.81) and Anxiety (M=.64) than those who selected surgery (M(action)=6.50; M(anxiety)=1.12) or radiation (M(action)=6.64; M(anxiety)=1.31; all p<.01). Finally, patients who actually received surgery had greater pre-existing Anxiety (M=1.09) than those who received active surveillance (M=.80), but this difference did not reach significance (p=.07). Action Bias was not predictive of treatment received (p=.54).
Conclusion: Prior to diagnosis, patients’ treatment preferences were related to Action Bias but not Anxiety. After diagnosis, treatment decisions were related to both Action Bias and Anxiety. Finally, treatment received was marginally related to Anxiety but not Action Bias. Together these findings reveal that relatively uninformed, preexisting individual differences can play a significant role in treatment decision-making, and that these factors may have varying degrees of impact at different points in the decision making process.