Sains Malaysiana 45(6)(2016): 941–947

Doctors' Approaches to Decision Support in Counseling Patients with Localized Prostate Cancer: An Asian perspective

(Pendekatan Doktor untuk Menyokong Keputusan dalam Memberi Kaunseling kepada

Pesakit Kanser Prostat Setempat: Perspektif Asia)

AI THENG CHEONG¹*, PING YEIN LEE¹, CHIRK JENN NG², YEW KONG LEE², TENG AIK ONG³, KHATIJAH LIM ABDULLAH⁴ & AZAD HASSAN ABDUL RAZACK³

¹Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia

²Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia

³Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia

⁴Department of Nursing Science, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia

Received: 28 September 2015/Accepted: 16 December 2015

ABSTRACT

There are many treatment options for localized prostate cancer, and there is clinical equipoise in relation to the treatment outcomes. This study aimed to explore doctors’ approaches to decision support in counseling patients with localized prostate cancer in a country with a less established system of support and care delivery for cancer treatment. Four in-depth interviews and three focus group discussions were conducted with seven government policy makers/consultant urologists, three oncologists, four private urologists and six urology trainees in Malaysia between 2012 and 2013. Doctors facilitated the treatment decision by explaining about the disease and the treatment options, which included monitoring, side effects and complications of each treatment option. Paper-based (charts and diagram drawings) or electronic (ipad apps and websites) illustrations and physical models were used as patient education aids. Further reading materials and websites links were often provided to patients. Patients were given time till subsequent follow up to decide on the treatment and family involvement was encouraged. Referral to other healthcare professionals (oncologist, radiotherapist or other urologist) for second opinion was offered to the patients. The doctors would recommend patients to speak to prostate cancer survivors for peer support but official support groups were not easily accessible. This study highlighted a multi-faceted approach to support patients with localized prostate cancer in making a treatment decision. It not only involved the doctors (urologist or oncologist) themselves, but also empowered the patients and their social network to support the decision making process.

Keywords: Decision making support; prostate cancer; qualitative; treatment

ABSTRAK

Terdapat banyak pilihan rawatan untuk kanser prostat setempat, dan terdapat soal keseimbangan faedah klinikal berhubung dengan pelbagai hasil rawatan. Kajian ini bertujuan untuk meneroka pendekatan doktor dalam menyokong pesakit kanser prostat setempat untuk membuat keputusan rawatan semasa kaunseling di negara yang kekurangan sistem sokongan yang mantap untuk rawatan kanser. Empat temu bual mendalam dan tiga kumpulan perbincangan fokus telah dijalankan dengan tujuh orang penggubal dasar kerajaan/perunding urologi, tiga orang pakar onkologi, empat orang pakar urologi swasta dan enam orang pelatih urologi di Malaysia antara tahun 2012 dan 2013. Doktor memudahkan keputusan rawatan dengan menjelaskan mengenai penyakit tersebut dan pilihan rawatan, di mana ia termasuk cara pemantauau, kesan sampingan dan komplikasi setiap pilihan rawatan. Ilustrasi berasaskan kertas (carta dan lukisan rajah) atau elektronik (aplikasi ipad dan laman web) dan fizikal model telah digunakan sebagai alat bantuan pendidikan pesakit. Bahan-bahan bacaan lanjut dan laman web pautan sering diberikan kepada pesakit. Pesakit telah diberi masa sehingga susulan berikutnya untuk membuat keputusan mengenai rawatan dan penglibatan keluarga adalah digalakkan. Rujukan kepada profesional kesihatan yang lain (pakar onkologi, radioterapi atau pakar urologi yang lain) bagi memperolehi pendapat kedua telah ditawarkan kepada pesakit. Para doktor akan mengesyorkan pesakit untuk berbual dengan bekas pesakit kanser prostat untuk mendapat sokongan rakan sebaya tetapi kumpulan sokongan rasmi tidak mudah didapati. Kajian ini menekankan pendekatan yang pelbagai untuk menyokong pesakit kanser prostat dalam membuat keputusan rawatan. Ia bukan sahaja melibatkan doktor (pakar urologi atau pakar onkologi) diri mereka sendiri, tetapi juga menggalakkan pesakit sendiri dan rangkaian sosial mereka untuk menyokong proses membuat keputusan.

Kata kunci: Kanser prostat; kualitatif; rawatan; sokongan membuat keputusan

REFERENCES

Bogdan, R. & Taylor, S. 1975. Introduction to Qualitative Research Methods. New York: John Wiley.

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

Cox, J. & Amling, C.L. 2008. Current decision-making in prostate cancer therapy. Curr. Opin. Urol. 18(3): 275-278.

Elwyn, G., Edwards, A., Kinnersley, P. & Grol, R. 2000. Shared decision making and the concept of Equipoise: The competences of involving patients in healthcare choices. Br. J. Gen. Pract. 50(460): 892-899.

Feldman-Stewart, D., Brundage, M.D. & Tong, C. 2011. Information that affects patients’ treatment choices for early stage prostate cancer: A review. Can. J. Urol. 18(6): 5998-6006.

Gebele, C., Tscheulin, D.K., Lindenmeier, J., Drevs, F. & Seemann, A-K. 2014. Applying the concept of consumer confusion to healthcare: Development and validation of a patient confusion model. Health Serv. Manage. Res. 27(1- 2): 10-21.

Jemal, A., Bray, F., Center, M.M., Ferlay, J., Ward, E. & Forman, D. 2011. Global cancer statistics. CA Cancer J. Clin. 61(2): 69-90.

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

Lee, Y.K., Low, W.Y., Lee, P.Y. & Ng, C.J. 2015. Factors influencing decision-making role preferences: A qualitative study of Malaysian patients with Type 2 diabetes during insulin initiation. Int. J. Nurs. Pract. 21(Suppl. 2) (May): 125-131.

Lin, G.A., Aaronson, D.S., Knight, S.J., Carroll, P.R. & Dudley, R.A. 2009. Patient decision aids for prostate cancer treatment: A systematic review of the literature. CA Cancer J. Clin. 59(6): 379-390.

Management of Localised Prostate Cancer. 2012. Watchful waiting, surgery or radiation therapy, depending on the natural course, which is often relatively slow. Prescrire Int. 21(131): 242-248.

Nieder, A.M. 2009. A Team Approach to Prostate Cancer. http:// copingmag.com/cwc/index.php/article/a_team_approach_to_ treating_prostate_cancer. Accessed on November 11, 2014.

O'Connor, A., Llewellyn-Thomas, H. & Stacey, D. 2005. IPDAS Collaboration Background Document. http://ipdas.ohri.ca/ ipdas_background.pdf. Accessed on June 4, 2015.

Patton, MQ. 1980. Qualitative Evaluation Methods. Newbury Park, CA: Sage.

Pope, C. & Mays, N. 1995. Reaching the parts other methods cannot reach: An introduction to qualitative methods in health and health services research. BMJ 311(6996): 42-45.

Shaw, E.K., Scott, J.G. & Ferrante, J.M. 2013. The influence of family ties on men’s prostate cancer screening, biopsy and treatment decisions. Am. J. Mens Health 7(6): 461-471.

Sothilingam, S., Sundram, M., Malek, R. & Sahabuddin, R.M. 2010. Prostate cancer screening perspective, Malaysia. Urol. Oncol. 28(6): 670-672.

Spiegle, G., Al-Sukhni, A., Schmocker, S., Gagliardi, A.R., Victor, J.C., Baxter, N.N. & Kennedy, E.D. 2013. Patient decision aids for cancer treatment: Are there any alternatives? Cancer 119(1): 189-200.

Steginga, S.K., Ferguson, M., Clutton, S., Gardiner, R.A.F. & Nicol, D. 2008. Early decision and psychosocial support intervention for men with localised prostate cancer: An integrated approach. Support Care Cancer 16(7): 821-829.

Urologist Directory. Malaysian Urological Association - Continued Medical Education. http://www.muacme.org/ urologist.php. Accessed April 28, 2015.

Wilt, T.J., MacDonald, R., Rutks, I., Shamliyan, T.A., Taylor, B.C. & Kane, R.L. 2008. Systematic review: Comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann. Intern Med. 148(6): 435-448.

Wyatt, K.D., Branda, M.E., Anderson, R.T., Pencille, L.J., Montori, V.M., Hess, E.P., Ting, H.H. & LeBlanc, A. 2014. Peering into the black box: A meta-analysis of how clinicians use decision aids during clinical encounters. Implement Sci. 9: 26.

Zainal Ariffin, O. & Nor Saleha, I.T. 2011. National Cancer Registry Report, 2007. Ministry of Health, Malaysia. www.moh.gov.my/images/gallery/Report/Cancer/Report_Cancer_2007-3.pdf. Accessed on June 5, 2015.

Zeliadt, S.B., Penson, D.F., Moinpour, C.M., Blough, D.K., Fedorenko, C.R., Hall, I.J., Smith, J.L., Ekwueme, D.U., Thompson, I.M., Keane, T.E. & Ramsey, S.D. 2011. Provider & partner interactions in the treatment decision-making process for newly diagnosed localized prostate cancer. BJU Int. 108(6): 851-856.

Zeliadt, S.B., Ramsey, S.D., Penson, D.F., Hall, I.J., Ekwueme, D.U., Stroud, L. & Lee, J.W. 2006. Why do men choose one treatment over another?: A review of patient decision making for localized prostate cancer. Cancer 106(9): 1865-1874.

*Corresponding author; email: cheaitheng@upm.edu.my