Optimizing psychosocial support in prostate cancer patients during active surveillance. Active Surveillance Psychosocial Support (ASPS) Study.
Summary
Optimizing psychosocial support in prostate cancer patients undergoing active surveillance.
Background: Prostate Cancer (PCa) is diagnosed more often. Active Surveillance (AS) is the preferred treatment option in low-risk PCa. During AS patients do not undergo active treatment but remain under close surveillance. Although this is beneficial to both patient and healthcare system, living with untreated disease can cause anxiety and uncertainty. Aim: The aim of this study was to identify psychosocial support needs in PCa patients undergoing AS. Methods: During this explorative qualitative study, 17 semi-structured interviews were conducted. Fifteen participants underwent AS, one was opting for treatment after recent diagnosis and one underwent active treatment after initial AS. After verbatim transcription, iterative inductive open-coded analysis using NVIVO 10 was performed. Results: Seven major themes emerged: impact of diagnosis, patient-physician relationship, coping strategies, AS challenges, PSA rituals, and practical or emotional support needs. Most evident was the apparent association between effective coping strategies, disease acceptation, external locus-of-control and positive patient-physician relationships. Ineffective coping strategies, i.e. avoidance and denial, seemed to impede stress resilience. Immediate availability of reliable information on disease and treatment after diagnosis contributed to disease acceptation. Lifestyle changes and PSA rituals seemed to provide a sense of disease-control. Conclusions: During AS, patients face the burden of frequent medical examinations and living with untreated disease. The specific psychosocial support needs in this group were previously unknown. This research suggests that the negative psychosocial impact of AS can be reduced if caregivers answer the following needs: promote disease acceptation, stimulate adoption of effective coping strategies and encourage meaningful lifestyle changes. Implications: The development of a support program addressing these needs should incorporate early-stage reliable and relevant information, assessment of coping strategies, promotion of effective coping strategies and facilitations of health promoting lifestyle changes. Further research should investigate the operational details of this program and its feasibility.