Supporting Patients in Making Treatment Decisions for Early Prostate Cancer: A Qualitative Study of Healthcare Professionals’ Views on Barriers and Challenges in an Asian Country

Background: The aim of this study is to explore the challenges faced by healthcare professionals (HCPs) in Malaysia in supporting patients with early prostate cancer in making treatment decisions.

Methods: Four in-depth individual interviews and three focus group discussions were conducted with urologists (n=11), urology trainees (n=5), oncologists (n=3) and policy makers (n=1) in Malaysia in 2012-2013. A semi-structured interview guide was used to facilitate the interviews, which were audio-recorded, transcribed verbatim and checked. Thematic approach was used to analyze the data.

Results: Challenges reported by HCPs in supporting patients in making decisions about prostate cancer treatment consisted of patient, social, healthcare professionals and health system factors. Patient-related challenges were: distrust of HCPs, difficulty in communicating information, preconceptions, attitudes to treatment, preparedness for decision making, viewing prostate cancer as taboo and fear of treatment complications, or side-effects. Social factors, such as influence of family or others, also posed a problem for HCPs seeking to support patients’ decision-making. HCP-related challenges included: differences of opinion among HCPs, uncertainty about the best treatment option and lack of interdisciplinary cooperation. Healthcare system factors challenges included: lack of support staff, time constraints, treatment availability and treatment costs. HCPs suggested that delivery of care by multi-disciplinary teams, and more use of audio-visual media, would help patients to make decisions. Conclusions: HCPs faced various challenges in supporting patients with prostate cancer in making decisions about treatment. Delivery of care by a supportive team in a specialist centre may improve the support patients receive in making decisions. 

Cancer, decision, prostate, support, treatment

1. Heidenreich MB, S. Joniau, M.D. Mason, V. Matveev, N. Mottet, H-P. Schmid, T.H. van der Kwast, T. Wiegel, F. Zattoni. Guidelines on prostate cancer: European Association of Urology, 2011.

2. Holmboe ES, Concato J. Treatment decisions for localized prostate cancer: asking men what’s important. Journal of General Internal Medicine 2000;15(10):694-701.

3. Fowler FJ, Jr., McNaughton Collins M, Albertsen PC, Zietman A, Elliott DB, Barry MJ. Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer. JAMA 2000;283(24):3217-22.

4. Chan EC, Vernon SW, O’Donnell FT, Ahn C, Greisinger A, Aga DW. Informed Consent for cancer screening with prostate-specific antigen: how well are men getting the message? American Journal of Public Health 2003;93(5):779-85.

5. Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, et al. Race, gender, and partnership in the patient-physician relationship. JAMA 1999;282(6):583-9.

6. Perkins HS, Geppert CM, Gonzales A, Cortez JD, Hazuda HP. Cross-cultural similarities and differences in attitudes about advance care planning. Journal of General Internal Medicine 2002;17(1):48-57.

7. McNutt RA. Shared medical decision making: problems, process, progress. JAMA 2004;292(20):2516-8.

8. Devereaux PJ, Anderson DR, Gardner MJ, Putnam W, Flowerdew GJ, Brownell BF, et al. Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study. BMJ 2001;323(7323):1218-22.

9. Bruera E, Willey JS, Palmer JL, Rosales M. Treatment decisions for breast carcinoma: patient preferences and physician perceptions. Cancer 2002;94(7):2076-80.

10.  Woolf SH, Chan EC, Harris R, Sheridan SL, Braddock CH, 3rd, Kaplan RM, et al. Promoting informed choice: transforming health care to dispense knowledge for decision making. Annals of Internal Medicine 2005;143(4):293-300.

11.  Farooqui M, Hassali MA, Shatar AK, Shafie AA, Seang TB, Farooqui MA. A qualitative exploration of Malaysian cancer patients’ perspectives on cancer and its treatment. BMC Public Health 2011;11:525.

12.  Department of Statistics. General Report of Population and Housing Census 2000. Kuala Lumpur, Malaysia, 2005.

13. Patel HR, Mirsadraee S, Emberton M. The patient’s dilemma: prostate cancer treatment choices. The Journal of Urology 2003;169(3):828-33.

14.  Bogdan R, S.J. Taylor . Introduction to qualitative research methods. New York John Wiley, 1975 

15.  Pope C, Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ 1995;311(6996):42-5.

16.  Patton MQ. Qualitative evaluation methods 1980 Newbury Park, CA: Sage, 1980.

17.  Kitzinger J. Qualitative research. Introducing focus groups. BMJ 1995;311(7000):299-302.

18.  Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3(2):77-101.

19.  Wofford MM, Wofford JL, Bothra J, Kendrick SB, Smith A, Lichstein PR. Patient complaints about physician behaviors: a qualitative study. Academic Medicine: Journal of the Association of American Medical Colleges 2004;79(2):134-8.

20.  Sommers BD, Beard CJ, D’Amico AV, Kaplan I, Richie JP, Zeckhauser RJ. Predictors of patient preferences and treatment choices for localized prostate cancer. Cancer 2008;113(8):2058-67.

21.  Kim SP, Knight SJ, Tomori C, Colella KM, Schoor RA, Shih L, et al. Health literacy and shared decision making for prostate cancer patients with low socioeconomic status. Cancer Investigation 2001;19(7):684-91.

22.  Randhawa G, Owens A. The meanings of cancer and perceptions of cancer services among South Asians in Luton, UK. British Journal of Cancer 2004;91(1):62-8.

23.  Wong-Kim E, Sun A, DeMattos MC. Assessing cancer beliefs in a Chinese immigrant community. Cancer Control : Journal of the Moffitt Cancer Center 2003;10(5 Suppl):22-8.

24.  Berry DL, Ellis WJ, Woods NF, Schwien C, Mullen KH, Yang C. Treatment decision-making by men with localized prostate cancer: the influence of personal factors. Urologic Oncology 2003;21(2):93-100.

25. Shaw EK, Scott JG, Ferrante JM. The influence of family ties on men’s prostate cancer screening, biopsy, and treatment decisions. American Journal of Men’s Health 2013;7(6):461-71.

26.  Zeliadt SB, Penson DF, Moinpour CM, Blough DK, Fedorenko CR, Hall IJ, et al. Provider and partner interactions in the treatment decision-making process for newly diagnosed localized prostate cancer. BJU International 2011;108(6):851-6; discussion 56-7.

27. Access to Clinical NurseSpecialists for men with prostate cancer. The Prostate Cancer Charity policy position August 2009.