Patient perspectives on factors influencing active surveillance adherence for low-risk prostate cancer: A qualitative study

Lalita Subramanian; Sarah T Hawley; Ted A Skolarus; Aaron Rankin; Michael D Fetters; Karla Witzke; Jason Chen; Archana Radhakrishnan

doi:10.1002/cam4.6847

Patient perspectives on factors influencing active surveillance adherence for low-risk prostate cancer: A qualitative study

Cancer Med. 2023 Dec 27;13(1):e6847. doi: 10.1002/cam4.6847. Online ahead of print.

Authors

Lalita Subramanian¹, Sarah T Hawley^{1

2}, Ted A Skolarus^{2

3}, Aaron Rankin¹, Michael D Fetters⁴, Karla Witzke⁵, Jason Chen¹, Archana Radhakrishnan^{1

2}

Affiliations

¹ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
² Center for Clinical Management Research, Health Services Research & Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
³ Department of Surgery, Urology Section, University of Chicago, Chicago, Illinois, USA.
⁴ Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁵ Department of Urology, MyMichigan Health, Midland, Michigan, USA.

Abstract

Background: Prostate cancer is the most common cancer among men in the United States. Treatment guidelines recommend active surveillance for low-risk prostate cancer, which involves monitoring for progression, to avoid or delay definitive treatments and their side effects. Despite increased uptake, adherence to surveillance remains a challenge.

Methods: We conducted semi-structured, qualitative, virtual interviews based on the Theoretical Domains Framework (TDF), with men (15) who were or had been on active surveillance for their low-risk prostate cancer in 2020. Interviews were transcribed and coded under TDF's behavioral theory-based domains. We analyzed domains related to adherence to surveillance using constructivist grounded theory to identify themes influencing decision processes in adherence.

Results: The TDF domains of emotion, beliefs about consequences, environmental context and resources, and social influences were most relevant to surveillance adherence-. From these four TDF domains, three themes emerged as underlying decision processes: trust in surveillance as treatment, quality of life, and experiences of self and others. Positive perceptions of these three themes supported adherence while negative perceptions contributed to non-adherence (i.e., not receiving follow-up or stopping surveillance). The relationship between the TDF domains and themes provided a theoretical process describing factors impacting active surveillance adherence for men with low-risk prostate cancer.

Conclusions: Men identified key factors impacting active surveillance adherence that provide opportunities for clinical implementation and practice improvement. Future efforts should focus on multi-level interventions that foster trust in surveillance as treatment, emphasize quality of life benefits and enhance patients' interpersonal experiences while on surveillance to optimize adherence.

Keywords: active surveillance; primary care physicians; prostate cancer; quality of life; trust; urologists.

Abstract

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