Describing Perspectives of Health Care Professionals on Active Surveillance for the Management of Prostate Cancer

When diagnosed with low-risk prostate cancer, men are involved in the decision about active surveillance as an option for disease management. They are asked to learn about the disease and different treatment options during a time of distress and to embark on a course of action that may counter their expectations. We investigated how men made their decisions and interrogated their conversations with physicians about their choices. We sought to understand how clinicians approached these conversations since the practice involving discussions about active surveillance is not yet defined and is still developing. These conversations are critical for helping men to understand the situation and the emerging evidence, and to facilitate an informed decision about active surveillance.

This article reports on a series of 5 focus groups with healthcare practitioners, exploring their perspectives about active surveillance. The sessions were held in several hospitals that specialize in the treatment of prostate cancer and included 48 physicians who provided care to men with low-risk prostate cancer and engaged in conversations with the men and their families about active surveillance We explored their practice approaches regarding active surveillance, how they proceeded with conversations, and what they saw as barriers and facilitators to men’s decision-making for active surveillance. The sessions were audiotaped and subjected to a conventional content analysis.

Overall the practitioners supported active surveillance as an appropriate course of action for men with low-risk prostate cancer. They saw the benefits of postponing interventional treatment unless there was a pressing reason for pursuing it. Practitioners acknowledged the challenges in explaining all the necessary details regarding active surveillance as well as other treatment options, especially in a busy clinical setting and at a time when patients were distressed. They found that men were accepting of active surveillance once they had learned about the potential for avoiding interventional side effects and their own low risk.

Of note, practitioners did not utilize standardized ways of assessing men’s learning, preferences, distress levels or quality of life, yet all of these factors were taken into account by the patients in their decision-making. We also noted that there were few standardized approaches to patient education.

Practitioners themselves expressed concerns about the rapidly evolving and non-standardized guidelines for patient follow-up. They pointed out the need for better tools to identify which patients were best suited for active surveillance in both the short and long term. Specialists and general practitioners also expressed concerns about their specific roles in patient care and support. These insights highlighted areas for better communication and education for greater uptake of active surveillance and improved person-centered care.

Written by: Margaret I. Fitch, Ph.D. Professor Faculty of Nursing at the University of Toronto, Canada

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