BERKELEY, CA (UroToday.com) - The objective of this study was to evaluate how men treated for localized prostate cancer perceive uncertainty and danger. Specifically, the study assessed how these two factors influence a patient’s satisfaction with his cancer care 4 to 6 years after his treatment. In total, 328 men identified from the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA) cohort [1] participated in phone interviews in which 3 survey instruments were administered, including the Mishel Uncertainty Illness Scale-Community Form, the Folkman and Lazarus’ Danger Appraisal Scale, and the Service Satisfaction Scale for Cancer Care.
Mishel first introduced the concept of uncertainty as a determinant of the state of health in 1981.[2] Uncertainty results when a patient is not given adequate cues or information to formulate what he perceives as a complete personal understanding of his disease. Subsequent studies have suggested that the impact of uncertainty on a cancer survivor’s health state is mediated by his perception of danger.[3,4] Previously, Germino and colleagues reported marked differences in uncertainty related to race, culture, and social environment, but not treatment modality (surgery vs. radiation) and noted correlations between level of uncertainty and patient’s ability to cope with their diagnosis.[5] More recent trials of interventions to counter uncertainty led by Mishel in men with localized and advanced prostate cancer suggest that illness uncertainty can have a profoundly negative impact on a patient’s health related quality of life (HRQOL).[6]
In this study, patients’ perception of danger correlated strongly with uncertainty (r=0.34, p<0.001) and both danger and uncertainty were strongly negatively correlated with patients’ reported satisfaction with their treatment outcomes (p=-0.30 and -0.33 respectively, p < 0.001). Interestingly, uncertainty levels were reported more in older patients, those with lower levels of education, and in African American men. Therapeutic modality was only marginally associated with the perception of danger and satisfaction of treatment outcome. Interestingly, perception of danger was modified by the planned treatment in younger men, with younger men who underwent radical prostatectomy reporting higher levels of danger than those undergoing radiation.
The findings of this study are important both as they extend our understanding of prostate cancer survivors’ uncertainty and perception of danger regarding their diagnoses of prostate cancer. It is the first study to assess the influence of these factors on a man’s satisfaction with his overall cancer care outcome. This study details the perception of uncertainty, danger, and satisfaction of a large diverse population of cancer survivors across the USA that has been followed for 4-6 years after their treatment. We identify several specific demographic groups who may benefit from interventions to mitigate uncertainty and perception of danger, in order to improve their overall satisfaction with their cancer care, as well as their HRQOL.
One limitation of this study is, as a companion study to the ongoing PROSTQA longitudinal cohort, data collection was initiated several years following treatment and enrollment. Future studies are necessary to assess the evolution of uncertainty and danger from the time of diagnosis and during the process of selecting therapy through the peri-treatment period to follow-up. We are also in the process of evaluating these domains and their effect on satisfaction with outcome of prostate cancer care in the active surveillance population.
In conclusion, this study found that uncertainty and perception of danger in men treated for prostate cancer correlate with satisfaction with the outcome of their therapy. Furthermore, age, race, and level of education markedly influence these associations and may further impact a man’s satisfaction with his choice of therapy. The detrimental effects of uncertainty described in this study bring to light the potential benefit of targeted interventions to decrease uncertainty and perception of danger. These findings also argue for the potential benefit of increasing emphasis and focus on uncertainty and danger in both patient education and in the medical decision-making process to improve patient satisfaction with treatment outcome.
References:
- Sanda MG, Dunn RL, Michalski J et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008; 358:1250-61.
- Mishel MH. The measurement of uncertainty in illness. Nurs Res 1981; 30: 258–63
- Wallace M. The quality of life of men undergoing watchful waiting for prostate cancer. Oncol Nurs Forum 2003; 30:303-9.
- Bailry D, Wallace M, Mishel M. Watchful waiting and uncertainty in prostate cancer. J Clin Nurs 2007, 16: 731-41.
- Germino BB, Mishel MH, Belyea M, Harris L, Ware A, Mohler J. Uncertainty in prostate cancer: ethnic and family patterns. Cancer Pract 1998; 6: 107-13.
- Mishel MH, Belya M, Germino BB et al. Helping patients with localized prostate cancer manage uncertainty and treatment side effects: nurse-delivered psychoeducational intervention over the telephone. Cancer 2002; 94: 1854-66.
Written by:
Sarah P. Psutka MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Massachusetts General Hospital, Boston, MA USA
Uncertainty and perception of danger among patients undergoing treatment for prostate cancer - Abstract
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