Method: In-depth (telephone or in-person) interviews were conducted with 40 prostate cancer survivors who were diagnosed with a rising PSA after definite treatment for prostate cancer. The interview followed a written guide with semi-structured questions. Question development was guided by self-regulation theory, with an emphasis on cognitive and affective factors that have shown to influence decision making. Interviews lasted on average 25-30 minutes, were professionally transcribed and coded by a team of researchers.
Result: Participants were on average 69 y.o. (SD=7.61), well-educated (53.5% post-graduate), employed (52.5%), and Caucasian (92.5%); self-reported health was average (M=3.37; SD=.74; on a 5-point scale). Whereas the decision for the initial treatment was made within an average of 6 weeks, the decision to initiate hormone treatment could stretch over many months. Qualitative results indicated that at initial diagnosis, more patients reported making decisions independently, receiving a second opinion, speaking to survivors/patients to share their concerns, and receiving moral support from loved ones. With a diagnosis of a rising PSA, the majority of patients reported making their decision based on their physician’s preference and advice. Few patients sought a second opinion. Additionally, patients with a rising PSA level voiced a substantial amount of explicit expressions of confidence in their physicians and stated that they received a lot of support from their doctors.
Conclusion: Data suggest that patients’ relationships to their physicians at the time of a rising PSA have evolved to be very trusting and supportive as compared to the time of the initial diagnosis. The decision to treat a rising PSA can span many months, compared to the initial treatment decision. Timing and initiation of treatment is therefore heavily influenced by disease progression and the physician’s subsequent interpretation and recommendation. Thus, physicians have the opportunity to set repeated markers on when to act and make a decision as patients’ PSA levels rise. A certain level of patients’ decision fatigue might also determine a more passive role in patients’ decision making.