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Eliciting men’s preferences for decision-making relative to treatments of localized prostate cancer with a good or moderate prognosis

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Abstract

Purpose

In diseases where there is no real consensus regarding treatment modalities, promoting shared decision-making can contribute to improving safety and quality of care. This is the case in low- or intermediate-risk localized prostate cancer (PC) treatment. The aim of this study was to investigate the preferences guiding men’s decisions regarding the characteristics of the treatment strategies for PC to help physicians adopt a more patient-centered approach.

Methods

This prospective multicenter study used a discrete choice experiment (DCE). The attributes and the modalities were identified from a qualitative study and a literature review. Relative preferences were estimated using a logistic regression model. Interaction terms (demographic, clinical and socio-economic characteristics) were added to the model to assess heterogeneity in preferences.

Results

652 men were enrolled in the study and completed a questionnaire with 12 pairs of hypothetical therapeutic alternatives between which they had to choose. Men’s choices were significantly negatively influenced by the risk of impotence and urinary incontinence, death, and the length and frequency of care. They preferred treatments with a rescue possibility in case of deterioration or recurrence and the use of innovative technology. Surprisingly, the possibility of undergoing prostate ablation negatively influenced their choice. The results also highlighted differences in trade-offs according to socio-economic level.

Conclusion

This study confirmed the importance of considering patients’ preferences in the decision-making process. It appears essential to better understand these preferences to allow physicians to improve communication and promote case-by-case decision-making.

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Acknowledgements

The authors would like to thank Alexandre Matte for the literature review work performed at the start of the study, Alexandra Lamotte Felin for the logistic management of the study and Charley Robert-Viard for his help with formatting the article. They also thank Suzanne Rankin (Dijon-Bourgogne University Hospital) for proofreading and editing the manuscript.

Funding

This work was supported entirely by the National Cancer Institute (INCa) [2012-09/293/AB-SD]. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

Author information

Authors and Affiliations

  1. CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 7 bd Jeanne d’Arc, BP 87900, 21000, Dijon, France

    Catherine Lejeune, Abderrahmane Bourredjem & Christine Binquet

  2. Academic Department of Urology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, UPMC Sorbonne Universités, Paris, France

    Olivier Cussenot

  3. Department of Urology, Sainte Marie Clinic, Chalon-sur-Saône, France

    Guillaume Boudrant

  4. Department of Urology, Hospices Civils de Beaune, Beaune, France

    Frédéric Papillon

  5. Department of Urology, CHU-Tours University Hospital, Tours, France

    Franck Bruyère & Olivier Haillot

  6. Université Francois Rabelais de Tours, PRES Centre Val de Loire, Tours, France

    Franck Bruyère & Olivier Haillot

  7. Department of Urology, William Morey Hospital, Chalon-sur-Saône, France

    Nicolas Koutlidis & Sébastien Bassard

  8. Department of Urology, CHU Brest University Hospital, Brest, France

    Georges Fournier & Antoine Valeri

  9. Urology Center, Nancy, France

    Jean-Luc Moreau & Bruno Pierfitte

  10. Department of Urology, CHU University Hospital François Mitterrand, Dijon, France

    Morgan Moulin & Luc Cormier

  11. Normandie Univ, UniCaen, Inserm, Anticipe, 14000, Caen, France

    Célia Berchi

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  1. Catherine Lejeune
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Contributions

(1) Study: A. Conception and design of the study, B. Coordination, C. Supervision of the study. A: CL, CBi, LC. B: CL. C: CL, AB, CBe, CBi, LC. (2) Statistical analysis and interpretation: A. Design, B. Execution, D. Critical review and interpretation. A: AB and CBe. B: AB. C: CL, CBe, CBi, LC. (3) Manuscript: A. Writing the first draft, B. Writing the specific part of the statistical analysis, C. Critical review, D. Final approval. A: CL. B: AB. C: CL, CBe, CBi, OC, GB, FP, FB, OH, NK, SB, GF, AV, JL-M, BP, LC. D: CL, LC.

Corresponding author

Correspondence to Catherine Lejeune.

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Conflict of interest

There are any financial relationship or conflict of interest between any of the authors.

Ethical approval

The protocol was approved by the ethics committee CPP Est I (February 2013): ID RCB: 2012-A01281-42.

Iinformed consent

Written informed consent was obtained from each pilot and main study patient. Patients of the study have given prior written consent to collect data.

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Lejeune, C., Bourredjem, A., Binquet, C. et al. Eliciting men’s preferences for decision-making relative to treatments of localized prostate cancer with a good or moderate prognosis. World J Urol 41, 1541–1549 (2023). https://doi.org/10.1007/s00345-023-04416-w

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