Decision Regret in Patients with Localised Prostate Cancer: A Systematic Review and Meta-analysis

后悔 医学 前列腺癌 前列腺切除术 梅德林 荟萃分析 置信区间 放射治疗 癌症 内科学 肿瘤科 政治学 计算机科学 机器学习 法学
作者
Jack B. Fanshawe,Vinson Wai‐Shun Chan,Aqua Asif,Alexander Ng,Mieke Van Hemelrijck,Paul Cathcart,Ben Challacombe,Christian Brown,Rick Popert,Oussama Elhage,Kamran Ahmed,Oliver Brunckhorst,Prokar Dasgupta
出处
期刊:European Urology Oncology [Elsevier BV]
卷期号:6 (5): 456-466 被引量:12
标识
DOI:10.1016/j.euo.2023.02.005
摘要

Treatment choice for localised prostate cancer remains a significant challenge for patients and clinicians, with uncertainty over decisions potentially leading to conflict and regret. There is a need to further understand the prevalence and prognostic factors of decision regret to improve patient quality of life.To generate the best estimates for the prevalence of significant decision regret localised prostate cancer patients, and to investigate prognostic patient, oncological, and treatment factors associated with regret.We performed a systematic search of MEDLINE, Embase, and PsychINFO databases including studies evaluating the prevalence or patient, treatment, or oncological prognostic factors in localised prostate cancer patients. A pooled prevalence of significant regret was calculated with the formal prognostic factor evaluation conducted per factor identified.Significant decision regret was present in a pooled 20% (95% confidence interval 16-23) of patients across 14 studies and 17883 patients. This was lower in active surveillance (13%), with little difference between those who underwent radiotherapy (19%) and those who underwent prostatectomy (18%). Evaluation of individual prognostic factors demonstrated higher regret in those with poorer post-treatment bowel, sexual, and urinary function; decreased involvement in the decision-making process; and Black ethnicity. However, evidence remains conflicting, with low or moderate certainty of findings.A significant proportion of men experience decision regret after a localised prostate cancer diagnosis. Monitoring those with increased functional symptoms and improving patient involvement in the decision-making process through education and decision aids may reduce regret.We looked at how common regret in treatment decisions is after treatment for early-stage prostate cancer and factors linked with this. We found that one in five regret their decision, with those who had experienced side effects or were less involved in the decision-making process more likely to have regret. By addressing these, clinicians could reduce regret and improve quality of life.
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