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Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis

OBJECTIVE: To describe the lived experience of a possible prostate cancer overdiagnosis in men who resisted recommended treatment. DESIGN: Qualitative interview study SETTING: Australia PARTICIPANTS: 11 men (aged 59–78 years) who resisted recommended prostate cancer treatment because of concerns abo...

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Autores principales: McCaffery, Kirsten, Nickel, Brooke, Pickles, Kristen, Moynihan, Ray, Kramer, Barnett, Barratt, Alexandra, Hersch, Jolyn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537980/
https://www.ncbi.nlm.nih.gov/pubmed/31122983
http://dx.doi.org/10.1136/bmjopen-2018-026960
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author McCaffery, Kirsten
Nickel, Brooke
Pickles, Kristen
Moynihan, Ray
Kramer, Barnett
Barratt, Alexandra
Hersch, Jolyn
author_facet McCaffery, Kirsten
Nickel, Brooke
Pickles, Kristen
Moynihan, Ray
Kramer, Barnett
Barratt, Alexandra
Hersch, Jolyn
author_sort McCaffery, Kirsten
collection PubMed
description OBJECTIVE: To describe the lived experience of a possible prostate cancer overdiagnosis in men who resisted recommended treatment. DESIGN: Qualitative interview study SETTING: Australia PARTICIPANTS: 11 men (aged 59–78 years) who resisted recommended prostate cancer treatment because of concerns about overdiagnosis and overtreatment. OUTCOMES: Reported experience of screening, diagnosis and treatment decision making, and its impact on psychosocial well-being, life and personal circumstances. RESULTS: Men’s accounts revealed profound consequences of both prostate cancer diagnosis and resisting medical advice for treatment, with effects on their psychological well-being, family, employment circumstances, identity and life choices. Some of these men were tested for prostate-specific antigen without their knowledge or informed consent. The men felt uninformed about their management options and unsupported through treatment decision making. This often led them to develop a sense of disillusionment and distrust towards the medical profession and conventional medicine. The findings show how some men who were told they would soon die without treatment (a prognosis which ultimately did not eventuate) reconciled issues of overdiagnosis and potential overtreatment with their own diagnosis and situation over the ensuing 1 to 20+ years. CONCLUSIONS: Men who choose not to have recommended treatment for prostate cancer may avoid treatment-associated harms like incontinence and impotence, however our findings showed that the impact of the diagnosis itself is immense and far-reaching. A high priority for improving clinical practice is to ensure men are adequately informed of these potential consequences before screening is considered.
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spelling pubmed-65379802019-06-12 Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis McCaffery, Kirsten Nickel, Brooke Pickles, Kristen Moynihan, Ray Kramer, Barnett Barratt, Alexandra Hersch, Jolyn BMJ Open Communication OBJECTIVE: To describe the lived experience of a possible prostate cancer overdiagnosis in men who resisted recommended treatment. DESIGN: Qualitative interview study SETTING: Australia PARTICIPANTS: 11 men (aged 59–78 years) who resisted recommended prostate cancer treatment because of concerns about overdiagnosis and overtreatment. OUTCOMES: Reported experience of screening, diagnosis and treatment decision making, and its impact on psychosocial well-being, life and personal circumstances. RESULTS: Men’s accounts revealed profound consequences of both prostate cancer diagnosis and resisting medical advice for treatment, with effects on their psychological well-being, family, employment circumstances, identity and life choices. Some of these men were tested for prostate-specific antigen without their knowledge or informed consent. The men felt uninformed about their management options and unsupported through treatment decision making. This often led them to develop a sense of disillusionment and distrust towards the medical profession and conventional medicine. The findings show how some men who were told they would soon die without treatment (a prognosis which ultimately did not eventuate) reconciled issues of overdiagnosis and potential overtreatment with their own diagnosis and situation over the ensuing 1 to 20+ years. CONCLUSIONS: Men who choose not to have recommended treatment for prostate cancer may avoid treatment-associated harms like incontinence and impotence, however our findings showed that the impact of the diagnosis itself is immense and far-reaching. A high priority for improving clinical practice is to ensure men are adequately informed of these potential consequences before screening is considered. BMJ Publishing Group 2019-05-23 /pmc/articles/PMC6537980/ /pubmed/31122983 http://dx.doi.org/10.1136/bmjopen-2018-026960 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Communication
McCaffery, Kirsten
Nickel, Brooke
Pickles, Kristen
Moynihan, Ray
Kramer, Barnett
Barratt, Alexandra
Hersch, Jolyn
Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis
title Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis
title_full Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis
title_fullStr Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis
title_full_unstemmed Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis
title_short Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis
title_sort resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537980/
https://www.ncbi.nlm.nih.gov/pubmed/31122983
http://dx.doi.org/10.1136/bmjopen-2018-026960
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