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

Journal

EUROPEAN UROLOGY ONCOLOGY
Volume 6, Issue 5, Pages 456-466

Publisher

ELSEVIER
DOI: 10.1016/j.euo.2023.02.005

Keywords

Decision regret; Prostate cancer; Prognostic factors; Quality of life

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Significant decision regret is present in 20% of localised prostate cancer patients, with factors such as poorer post-treatment functional outcomes and decreased involvement in decision-making process associated with higher regret. Addressing these factors through improved patient education and involvement may help reduce regret and improve quality of life.
Context: 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.Objective: 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.Evidence acquisition: 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.Evidence synthesis: Significant decision regret was present in a pooled 20% (95% confidence interval 16-23) of patients across 14 studies and 17 883 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.Conclusions: 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.Patient summary: 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.(c) 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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