Informed choices: Patients' and healthcare professionals' perspectives on high-risk prostate cancer treatment decision-making.

Abstract

Patients with non-metastatic, high-risk prostate cancer (HR PCa) often face a choice between radical prostatectomy (RP) and external beam radiation therapy (EBRT), typically combined with androgen deprivation therapy (ADT). We explored the considerations that lead patients to prefer either RP or EBRT with or without ADT. To contextualize these preferences, we examined how treatment information provision for HR PCa patients is organized in Dutch hospitals and how it is experienced by both patients and healthcare professionals (HCPs). We conducted semi-structured interviews with HR PCa patients eligible for RP and EBRT±ADT participating in the RECOVER study (n = 20), and with HCPs involved in PCa care (n = 17). Two interview guides were developed, one for patients and one for HCPs. Interviews were transcribed verbatim and analysed thematically. Three themes emerged: (1) Considerable interhospital variation exists in the organization of information provision. Urologists and nurses often provided treatment information, radiation oncologists were rarely involved. Nurses fulfilled diverse roles, including ensuring patient understanding, supplementing treatment information, and providing emotional support; (2) Personalization is needed despite general satisfaction. Patients and HCPs emphasized the need for a more personalized approach to information provision. HCPs suggested that increased involvement of radiation oncologists could enhance objectivity; and (3) Patients' treatment decisions reflect perceived HCPs' preferences. Although patients perceived themselves as autonomous, treatment decisions consistently aligned with HCPs' recommendations. Other aspects influencing decisions included concerns about treatment-related side effects and psychological considerations, such as reassurance derived from tumour removal. Treatment decisions were influenced by concerns about treatment-related side effects, psychological considerations and HCPs' recommendations. Notably, the HCPs involved and their role in information provisions varied considerably across hospitals. Future efforts should focus on tailoring information to individual patient needs and strengthening multidisciplinary collaboration, especially by involving radiation oncologists more consistently. HCPs should remain aware of their influence on decision-making.