Factors that influence patient preferences for prostate cancer management options: A systematic review

Figures & data

Figure 1 Study selection results.

Abbreviation: CINAHL, Cumulative Index to Nursing & Allied Health Literature.

Table 1 Study characteristics including methodology, funding source, and quality, evaluated according to the PREFS checklist

References	Year	Country	N	Method	Att	Options (n)*	Subgroups	Funding	Q	P	R	E	F	S
Anandadas et al^Citation22	2011	UK	768	SPO	9	4	Management group	Industry	3	✓		✓	✓
Berry et al^Citation36	2006	USA	260	SPO	7	4	Men who consider age a factor in decisions	Govt	2	✓			✓
Bosco et al^Citation34	2012	USA	448	SPO	4	4	Decision aid intervention group	Govt	4	✓	✓		✓	✓
Chapple et al^Citation32	2002	UK	50	Qualitative (structured interview)	Ul	9	Management group	Govt	2	✓			✓
Davison et al^Citation33	2012	Canada	180	SPO	14	2	Participation in treatment decisions	Foundation	4	✓		✓	✓	✓
de Bekker-Grob et al^Citation21	2013	the Netherlands	110	DCE	5	3	None	Academic	4	✓		✓	✓	✓
Gwede et al^Citation24	2005	USA	119	Qualitative (structured interview)	8	2	Management group	Foundation	5	✓	✓	✓	✓	✓
Hall et al^Citation25	2003	USA	262	SPO	11	3	Management group	Govt, academic	4	✓	✓		✓	✓
Holmboe et al^Citation23	2000	USA	102	Qualitative (structured interview)	4	6	Likes and dislikes of treatment	Govt, academic	3	✓		✓	✓
Ihrig et al^Citation26	2011	Germany	31	SPO	7	2	Management goup	Academic	4	✓		✓	✓	✓
Mazur et al^Citation18	1996	USA	140	SPO	6	2	Management group	Govt	5	✓	✓	✓	✓	✓
Mazur et al^Citation19	1996	USA	140	SPO; TTO	6	2	None	Govt	4	✓	✓	✓	✓
Ramsey et al^Citation42	2010	USA	448	SPO	11	5	Management group	Govt	1				✓
Sidana et al^Citation27	2012	USA	493	SPO	15	3	Management group	Academic	3	✓			✓	✓
Sommers et al^Citation12	2008	USA	167	TTO	4	6	Management group	Govt, academic	4	✓		✓	✓	✓
Steginga et al^Citation43	2002	Australia	108	Qualitative (structured interview)	Ul	3	None	Govt, academic	2	✓			✓
van Tol-Geerdink et al^Citation29	2013	the Netherlands	240	SPO	5	3	Management group	Foundation	3	✓			✓	✓
Xu et al^Citation44	2011	USA	21	Qualitative (structured interview)	Ul	5	None	Foundation	3	✓		✓	✓
Xu et al^Citation31	2012	USA	21	Qualitative (structured interview)	Ul	2	None	Foundation	3	✓		✓	✓
Zeliadt et al^Citation28	2010	USA	198	SPO	10	5	Men considering only surgery versus multiple options	Govt	4	✓		✓	✓	✓
Zeliadt et al^Citation30	2008	USA	593	SPO	24	5	Men considering only surgery versus multiple options	Govt	4	✓		✓	✓	✓

Note:

* Number of treatment options included in the analysis.

Abbreviations: Att, number of attributes (characteristics of the treatment options); DCE, discrete choice experiment; E, explanation; F, findings; Govt, government; N, number of respondents; P, purpose; PREFS, Purpose, Respondents, Explanation, Findings and Significance; Q, quality score (based on PREFS checklist); R, responders; S, significance; SPO, stated preference (other); TTO, time trade-off; Ul, unlimited.

Figure S1 The number of studies included per publication year among the final set of 21 articles.

Table S1 Search strategy listed according to class of search terms

Class of search terms	Terms used
Diagnosis	“Prostate cancer” OR “prostate carcinoma” OR “prostate adenocarcinoma” OR [“prostate” AND (“cancer” OR “carcinoma” OR “adenocarcinoma” OR “malignant” OR “neoplasm”)]
Stage	“Localized” OR “organ-confined” OR “curative” OR “definitive” OR “encapsulated” OR “local” OR “nonmetastatic” OR “non-metastatic” OR “early stage” OR “early-stage”
Treatment	“Treatment” OR “therapy” OR “management” OR “surveillance” OR “watchful waiting” OR “radiation” OR “surgery” OR “prostatectomy” OR “brachytherapy”
Preference assessment	“Conjoint analysis” OR “satisfaction” OR “choice model” OR “stated preference” OR “discrete choice” OR “DCE” OR “decision analysis” OR “preferences” OR “multi-criteria decision analysis” OR “MCDA” OR “multi-attribute utility” OR “analytic hierarchy process” OR “trade off ” OR “self-explicated” OR “best-worst scaling” OR “utilities” OR “preference weight” OR “willingness to pay” OR “WTP” OR “willingness to accept” OR “contingent valuation” OR “priorities” OR “valuation”

Note: Each class was listed with “AND” between the classes.

Table S2 PREFS checklist for assessing quality of preference assessment reporting in the manuscripts included in the review

Question	Answer
	No/not clear	Yes
Purpose: Is the purpose of the study in relation to preferences clearly stated?	The purpose/research question/objectives/aim does not mention preference, but may mention satisfaction, quality of life, ratings, acceptance	Any reference in the research question/objectives/aim to preference, utility/disutility, willingness to pay, importance, priorities, goals, revealed preference (eg, choice to continue)
Respondents: Are the responders similar to the nonresponders?	Evidence of significant differences OR No assessment of the difference between responders and nonresponders OR Responders are compared only to a target population rather than nonresponders	Any evidence that the responders do not differ significantly from the nonresponders
Explanation: Are methods of assessing preferences clearly explained?	The question(s) or response options are not clear	The actual preference question is reported in the text or an appendix, or if it is referenced and available elsewhere, and if it is clear what response options were available to respondents, even if the mode of the question (eg, written, oral, online) is not clear OR For studies with multiple questions relating to preferences such as conjoint/discrete choice studies, it is clear what was presented to respondents and what responses were available
Findings: Were all respondents included in the reported findings and analysis of preference results?	Some responses are excluded from the analysis and the possibility of this introducing systematic bias has not been ruled out OR It is not clear whether all respondents were included in the analysis	All respondents who completed the preference question were included in the analysis OR For studies with multiple questions relating to preferences such as conjoint/discrete choice studies, all respondents who at least partially completed the preference questions were included in the analysis OR If some respondents who at least partially completed the preference questions were excluded from the analysis (eg, non-traders, lexicographic preferences, failed test question, irrational preferences, did not complete) AND there is any evidence that those excluded do not differ significantly from those included
Significance: Were significance tests used to assess the preference results?	The study reports only proportions, counts, graphs, etc	The study reports P-values, P-value ranges (eg, P<0.05), confidence intervals, means with standard deviations or standard errors in relation to the preference results (eg, testing the preference hypotheses or study objectives)

Notes: Table reproduced from Springer and PharmacoEconomics, 31, 2013, 877–892, Joy SM, Little E, Maruthur NM, et al. Patient preferences for the treatment of type 2 diabetes: a scoping review, Table 1, Copyright © Springer International Publishing Switzerland 2013, with kind permission from Springer Science and Business Media.¹

Table S3 Major findings and themes presented in each of the articles included in the review

References	Major findings or themes
Anandadas et al^Citation2	Most men who chose RP wanted physical removal of the cancer (60%). Approximately 27% of men who chose EBRT did so from fear of other treatment options. The main reason for choosing BT was more convenient for their lifestyle (39%).
Berry et al^Citation3	Personal perceptions of outcomes were highly influential. Longevity and bowel, bladder, and sexual function concerns most influential. Impact on work and recreation activities also influential. Majority (70%) reported a specific influence of age on treatment outcomes.
Bosco et al^Citation4	When side effects influenced treatment decisions, most commonly combination of all three (bowel, bladder, and sexual) rather than one or two. Less than half of patients chose treatment option concordant with stated concerns.
Chapple et al^Citation5	This qualitative study found that men who choose AS face pressure from family members to pursue active treatment.
Davison et al^Citation6	Four main factors influenced management decisions: urologist’s recommendation, impact of treatment on urinary function, age at time of diagnosis, and impact of treatment on sexual function.
de Bekker-Grob et al^Citation7	Patients with anxious/depressed feeling were more likely to choose EBRT or RP than AS. Management choices were influenced by treatment modality and risk of urinary incontinence.
Gwede et al^Citation8	Patients who chose surgery stated a desire for best chance for cure. Patients who chose BT did so because it was the least painful, least invasive, promised to have the fewest side effects, was convenient, and avoided surgery.
Hall et al^Citation9	Patients who choose prostatectomy are more likely to state that the reason is evidence that it is the best procedure to cure their cancer. Patients who choose prostate BT are more likely to state that they did so because of side-effect profile. BT patients were more likely to report their decision was influenced by a physician’s preference than were RP patients.
Holmboe et al^Citation10	The most common dislikes for RP were incontinence and impotence, and the most common like was tumor removal. The most common dislikes of EBRT were long duration of treatment and diffuse targeting. The most common likes for BT were short duration of treatment, noninvasive, and focused targeting, while weak evidence was cited as a dislike. Intrinsic characteristics of treatment were cited more commonly than likelihood of side effects as a reason for choosing treatment.
Ihrig et al^Citation11	Concerns for possible treatment side effects were cited as a reason for choosing EBRT. Patients who chose RP were more likely to cite personal beliefs regarding surgery as a reason.
Mazur et al^Citation12	Most patients who preferred RP reported that their choice was most influenced by desire for complete cancer removal. Most patients who chose AS reported that avoiding surgical complications was their top priority.
Mazur et al^Citation13	One quarter of men in this study preferred AS even when RP was assumed to have a 10-year survival benefit. Older patients were also more likely to prefer AS.
Ramsey et al^Citation14	Men who choose RP are less likely to rank chances of problems with sexual function as very important. Men who rank convenience as a priority are more likely to choose BT.
Sidana et al^Citation15	Doctor’s recommendation was the most commonly cited reason for choosing a treatment. Among those who chose RP over RT, the most common reasons were best chance of cure, doctor recommended, and young age. Among those who chose RT over RP, the most common reasons were less invasive and fewer side effects.
Sommers et al^Citation16	The strongest predictor of management choice was type of physician seen when the survey was administered. QALYs for health states did not predict treatment choice.
Steginga et al^Citation17	Open-ended questions revealed that the most concerning side effects for RP are incontinence and impotence. The most concerning side effects for EBRT are bowel problems and skin burns.
van Tol-Geerdink et al^Citation18	Patients preferring BT valued sexual problems and convenience of the treatment more than patients choosing RP or EBRT.
Xu et al^Citation19	Perceptions of treatment efficacy and risks of side effects were the most influential contributors to patient preferences.
Xu et al^Citation20	Knowledge of AS is limited, and some men yield to pressure from family members and physicians to choose active treatment over AS.
Zeliadt et al^Citation21	Men who were concerned about the burden of treatment were more likely to prefer options other than RP. Men who prioritized treatment efficacy were more likely to consider only RP.
Zeliadt et al^Citation22	Men who prioritized risk of adverse effects were more likely to prefer nonsurgical options.

Abbreviations: AS, active surveillance; BT, brachytherapy; EBRT, external beam radiation therapy; QALYs, quality-adjusted life years; RP, radical prostatectomy.

AnandadasCNClarkeNWDavidsonSEEarly prostate cancer – which treatment do men prefer and why?BJU Int2011107111762176821083643

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BoscoJLHalpennyBBerryDLPersonal preferences and discordant prostate cancer treatment choice in an intervention trial of men newly diagnosed with localized prostate cancerHealth Qual Life Outcomes20121012312323021156

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DavisonBJBreckonEFactors influencing treatment decision making and information preferences of prostate cancer patients on active surveillancePatient Educ Couns20128736937422177658

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de Bekker-GrobEWBliemerMCDonkersBPatients’ and urologists’ preferences for prostate cancer treatment: a discrete choice experimentBr J Cancer201310963364023860533

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GwedeCKPow-SangJSeigneJTreatment decision-making strategies and influences in patients with localized prostate carcinomaCancer200510471381139016080181

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HallJDBoydJCLippertMCWhy patients choose prostatectomy or brachytherapy for localized prostate cancer: results of a descriptive surveyUrology20036140240712597956

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HolmboeESConcatoJTreatment decisions for localized prostate cancer: asking men what’s importantJ Gen Intern Med20001569470111089712

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IhrigAKellerMHartmannMTreatment decision-making in localized prostate cancer: why patients chose either radical prostatectomy or external beam radiation therapyBJU Int20111081274127821410634

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SommersBDBeardCJD’AmicoAVKaplanIRichieJPZeckhauserRJPredictors of patient preferences and treatment choices for localized prostate cancerCancer20081132058206718704993

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StegingaSKOcchipintiSGardinerRAMaking decisions about treatment for localized prostate cancerBJU Int200289325526011856106

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van Tol-GeerdinkJJWillem LeerJWeijermanPCChoice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aidBJU Int2013111456457322882966

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XuJNealeAVDaileyRKPatient perspective on watchful waiting/active surveillance for localized prostate cancerJ Am Board Fam Med201225676377023136314

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XuJNealeAVDaileyRKEgglySSchwartzKLPatient perspective on watchful waiting/active surveillance for localized prostate cancerJ Am Board Fam Med201225676377023136314

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ZeliadtSBMoinpourCMBloughDKPreliminary treatment considerations among men with newly diagnosed prostate cancerAme J Manag Care2010165e121e130

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ZeliadtSBRamseySDPotoskyALAssociation of preexisting symptoms with treatment decisions among newly diagnosed prostate cancer patientsPatient20081318920119493

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JoySMLittleEMaruthurNMPatient preferences for the treatment of type 2 diabetes: a scoping reviewPharmacoEconomics20133187789224081453

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AnandadasCNClarkeNWDavidsonSEEarly prostate cancer – which treatment do men prefer and why?BJU Int2011107111762176821083643

 PubMed Web of Science ®Google Scholar

BerryDLEllisWJRussellKJFactors that predict treatment choice and satisfaction with the decision in men with localized prostate cancerClin Genitourin Cancer20065321922617239276

 PubMed Web of Science ®Google Scholar

BoscoJLHalpennyBBerryDLPersonal preferences and discordant prostate cancer treatment choice in an intervention trial of men newly diagnosed with localized prostate cancerHealth Qual Life Outcomes20121012312323021156

 PubMed Web of Science ®Google Scholar

ChappleAZieblandSHerxheimerAIs ‘watchful waiting’ a real choice for men with prostate cancer? A qualitative studyBJU Int20029025726412133062

 PubMed Web of Science ®Google Scholar

DavisonBJBreckonEFactors influencing treatment decision making and information preferences of prostate cancer patients on active surveillancePatient Educ Couns20128736937422177658

 PubMed Web of Science ®Google Scholar

de Bekker-GrobEWBliemerMCDonkersBPatients’ and urologists’ preferences for prostate cancer treatment: a discrete choice experimentBr J Cancer201310963364023860533

 PubMed Web of Science ®Google Scholar

GwedeCKPow-SangJSeigneJTreatment decision-making strategies and influences in patients with localized prostate carcinomaCancer200510471381139016080181

 PubMed Web of Science ®Google Scholar

HallJDBoydJCLippertMCWhy patients choose prostatectomy or brachytherapy for localized prostate cancer: results of a descriptive surveyUrology20036140240712597956

 PubMed Web of Science ®Google Scholar

HolmboeESConcatoJTreatment decisions for localized prostate cancer: asking men what’s importantJ Gen Intern Med20001569470111089712

 PubMed Web of Science ®Google Scholar

IhrigAKellerMHartmannMTreatment decision-making in localized prostate cancer: why patients chose either radical prostatectomy or external beam radiation therapyBJU Int20111081274127821410634

 PubMed Web of Science ®Google Scholar

MazurDJHickamDHPatient preferences for management of local-ized prostate cancerWest J Med19961651–226308855681

 PubMedGoogle Scholar

MazurDJHickamDHMazurMDHow patients’ preferences for risk information influence treatment choice in a case of high risk and high therapeutic uncertainty: asymptomatic localized prostate cancerMed Decis Making199919439439810520677

 PubMed Web of Science ®Google Scholar

Ramsey et al

 Google Scholar

SidanaAHeranndezDJFengZTreatment decision-making for localized prostate cancer: what younger men choose and whyProstate2012721586421520163

 PubMed Web of Science ®Google Scholar

SommersBDBBeardCJD’AmicoAVKaplanIRichieJPZeck-hauserRJPredictors of patient preferences and treatment choices for localized prostate cancerCancer200811382058206718704993

 PubMed Web of Science ®Google Scholar

Steginga et al

 Google Scholar

van Tol-GeerdinkJJWillem LeerJWeijermanPCChoice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aidBJU Int2013111456457322882966

 PubMed Web of Science ®Google Scholar

Xu et al

 Google Scholar

XuJNealeAVDaileyRKEgglySSchwartzKLPatient perspective on watchful waiting/active surveillance for localized prostate cancerJ Am Board Fam Med201225676377023136314

 PubMed Web of Science ®Google Scholar

ZeliadtSBMoinpourCMBloughDKPreliminary treatment considerations among men with newly diagnosed prostate cancerAme J Manag Care2010165e121e130

 Web of Science ®Google Scholar

ZeliadtSBRamseySDPotoskyALAssociation of preexisting symptoms with treatment decisions among newly diagnosed prostate cancer patientsPatient20081318920119493

 PubMedGoogle Scholar