THE ROLE OF SELF-EFFICACY IN PROSTATE CANCER TREATMENT DECISION MAKING

Purpose:

Patients can experience prostate cancer treatment decision making as difficult and stressful. It is known that information provision often does not meet the need of patients. Many decision support interventions therefore aim at improving knowledge and deliberation, but little is known on the psychological factors involved to prostate cancer treatment decision making and potentially affecting the success of such interventions. Self-efficacy represents the belief that one is capable of doing what is needed to resolve a problem or difficult task. In prostate cancer treatment decision making it appears that this belief is just as important for optimal decision making as one’s objective capabilities (e.g. information processing).This study investigated the role of self-efficacy in prostate cancer treatment decision making and the consequences for quality of life (QoL).

Method:

Three hundred and fifty-one patients who were scheduled for prostate biopsy from ten Dutch hospitals were included in a longitudinal study. Participants received a paper-and-pencil questionnaire at three moments in time; before prostate biopsy (T0), after treatment decision making if biopsy was positive for prostate cancer (T1; n=70) and a follow-up around six months after receiving treatment (T2; n=48). Questionnaires included measures for self-efficacy and other personality factors (optimism, information seeking preferences, health literacy and numeracy), prostate cancer knowledge, decisional conflict, decisional regret and quality of life (EORTC QLQ-C30 and QLQ-PR25).

Result:

We found a direct effect from self-efficacy on decisional conflict (B= -.14, t=-2.13, p=.04) and QoL (B=14.42, t=3.20, p<.01) at T1. There was no interaction found between decisional conflict and QoL at T1. At T2 we found self-efficacy to reduce levels of decisional regret (B=-.44, t=-2.05, p=.05). QoL at T2 was negatively affected by decisional regret (B=-14.03, t=-3.43, p<.01). We did not observe an association between self-efficacy and prostate cancer knowledge. Significant correlations were found between self-efficacy and optimism (p< .01), information seeking preferences (p<.01), health literacy (p<.01) and subjective numeracy (p<.01).

Conclusion:

Self-efficacy appeared to be positively associated with lower levels of decisional conflict and decisional regret. Decision support interventions should therefore not only aim at providing excellent information, but should also screen for the level of self-efficacy. This could imply the deployment of other decision support instruments to patients with low self-efficacy compared to patients with high levels of self-efficacy.