Decisional regret on prostate cancer

Prof. Van Der Poel began by contextualising the significance of decisional regret as negative emotions and dissatisfaction experienced after a decision has been made. He emphasised the importance of not overloading patients with general information and stressed the need for individualised approaches. He shared four questions he wanted to answer about decisional regret: How to measure? Is it frequent? How does QoL affects it? How to avoid?

Prof. Van Der Poel stated that the most widely used tool to measure regret is the Decisional Regret Scale. Based on this tool, in a 2017 study published on World Journal of Surgery, it was identified that prostate cancer patients are more likely to regret their choice of treatment (24%) following by breast cancer patients (14%), sarcoma (20%), testis (10%) and non-oncology patients (6-14%). When examining the reasons for decision regret in prostate cancer patients, Prof. Van Der Poel highlighted several factors. These patients are often asymptomatic, have numerous treatment options to choose from, may experience effects on masculinity due to treatments, have a long-life expectancy which allows more time for regret, and there is a high prevalence of prostate cancer in men.

Regarding the comparison of symptoms after prostate cancer treatments, patients tend to express more regret about sexual problems compared to urinary problems. When considering the active involvement of the patient in the choice of treatment, Prof. Van Der Poel presented findings from two studies, one conducted in Germany and the other in the UK, which reached the same conclusion: patients are less likely to regret their treatment choice if they actively participate in the decision-making process.

Furthermore, Prof. Van Der Poel highlighted that decision regret regarding prostate cancer treatment choice is not limited to the immediate post-treatment period. Several studies have shown that even 16 years after treatment, patients still experience regret, particularly those with poor quality of life and an increased fear of PSA recurrence. In his concluding remarks, Prof. Van Der Poel summarised that younger men, those who do not actively participate in treatment choice, and those lacking social support, are more likely to regret their choices.

Ms. Tillier shared the nursing perspective in her presentation and noted that today, patients are increasingly seeking individualised information about potential treatment side effects, before making their choices. However, in clinical practice, it is often observed that most information about the side effects of prostate cancer treatments is delivered in a standardised manner. In such cases, patients may therefore have a misperception of the consequences of treatments which can ultimately lead to decisional regret. She also illustrated in her presentation how certain tools can aid in clinical practice, citing the existence of several individualised risk calculators for predicting urinary incontinence and ED after robot-assisted radical prostatectomy. However, despite their availability, external validation is still required.

Ms. Tillier also emphasised that to individualise the information it is imperative to consider the patient’s health literacy and adapt the interventions accordingly. By taking this into account, we can ensure greater equity in nursing care and promote better patient compliance. In her closing remarks, she stressed the importance of good communication between nurses and patients in shared decision-making. She advocated for a shift towards a clinical setting where standardised information is replaced by individualised approaches.

—

By Mr. Taigo Santos (PT)