To identify and explore barriers to, and enablers of active surveillance (AS) in men with low-risk prostate cancer (LRPC), as perceived by prostate cancer clinicians.
Urologists and radiation oncologists in Australia and New Zealand were purposively sampled for a cross-section on gender and practice setting (metropolitan/regional; public/private). Using a grounded theory approach, semi-structed interviews were conducted with participants. Interviews were coded independently by two researchers using open, axial and selective coding. A constant comparative approach was used to analyse data as it was collected. Thematic saturation was reached after 18 interviews, and a detailed model of barriers to, and enablers of, AS for prostate cancer, as perceived by clinicians was developed.
A model explaining what affects clinician decision making regarding AS in LRPC emerged. It was underpinned by three broad themes: (i) clinician perception of patients' barriers and enablers; (ii) clinician perception of their own barriers and enablers; and (iii) engagement with healthcare team and resource availability.
Clinicians unanimously agree that AS is an evidence-based approach for managing LRPC. Despite this many men do not undergo AS for LRPC, which is due to the interplay of patient and clinician factors, and their interaction with the wider healthcare system. This study identifies strategies to mitigate barriers and enhance enablers, which could increase access to AS by patients with LRPC.
BJU international. 2023 Sep 11 [Epub ahead of print]
Trent A Pattenden, Isaac A Thangasamy, Wee Loon Ong, Dhanika Samaranayke, Andrew Morton, Declan G Murphy, Susan Evans, Jeremy Millar, Venu Chalasani, Prem Rashid, Matthew Winter, Ian Vela, David Pryor, Stephen Mark, Stacy Loeb, Nathan Lawrentschuk, Elizabeth Pritchard
Department of Urology, Hospital, QLD, Ipswich, Australia., Nepean Urology Research Group, Nepean Hospital, NSW, Australia., Alfred Health Radiation Oncology, VIC, Australia., Division of Cancer Surgery, Peter MacCallum Cancer Centre, VIC, Australia., Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia., School of Medicine, University of Sydney, NSW, Australia., Port Macquarie Base Hospital, NSW, Australia., Department of Urology, Princess Alexandra Hospital, QLD, Australia., Department of Radiation Oncology, Princess Alexandra Hospital, QLD, Australia., Department of Urology, Christchurch Hospital, New Zealand., New York University, NY, USA.