Personality Predicts Prostate Cancer Treatment Decision-Making Difficulty And Satisfaction

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology;  Psychology / Psychiatry
Article Date: 03 Nov 2008 - 4:00 PDT

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UroToday.com - In the online edition of Psycho-Oncology, a group of American investigators reported on the link between personality and prostate cancer (CaP) decision-making and satisfaction. This intriguing paper evaluated the optimist's ability to engage more fully and effectively in coping with or meeting an important challenges and how optimism may also positively impact CaP decision-making outcomes. The group hypothesized that patients with greater optimism in CaP decision-making would be more satisfied and experience less difficulty with the process and that these effects would be partially mediated by their self-efficacy for making treatment decisions. In the research, they controlled for covariates to include the importance of treatment side effects, demographic characteristics and levels of agreement between preferred and perceived levels of decisional control.

The study cohort included 202 patients recently diagnosed with localized CaP. Of these, 159 (78.71%) returned the survey. Independent variables included optimism (assessed by the Life Orientation Test-Revised), and treatment decision-making self-efficacy (assessed by 3-questions). Dependent variables evaluated decision-making satisfaction (assessed with the Holmes-Rovner Decision Scale) and decision-making difficulty (assessed with 3 items). Covariates included influence of side effects, agreement between preferred and perceived levels of decisional control, and demographic characteristics.

Two sets of predictor variables were related. Optimism varied as a function of education, with more educated patients displaying greater optimism. Self-efficacy and agreement between preferred and perceived levels of decisional control were positively associated. Mean scores for the continuous predictor variables were 2.27 out of 4 for importance of side-effects, 3.71 out of 5 for optimism, and 2.67 out of 3 for decision-making self-efficacy. Difficulty with the decision was reported by 31%, indicating that they either agreed or strongly agreed with the statements about finding the decision process difficult. Hierarchical multiple regression revealed the relative contributions of the predictors to difficulty with decision-making, including the contributions of optimism, and treatment decision-making self-efficacy over and above those predictors of decision-making satisfaction previously reported in the literature. Demographic characteristics and agreement between preferred and perceived levels of decisional control did not contribute to the model. Influence of side effects contributed significantly to the model. Optimism was added to the model and explained an additional 7% of the variability in difficulty, and decision-making self-efficacy accounted for an additional 8% of the variability in decision-making difficulty. Controlling for other variables in the model, a unit increase in self-efficacy was associated with a 0.70-point reduction in difficulty on a scale ranging from 1 to 5. When all the variables were in the equation, influence of side effects, race and education were significant predictors of treatment decision-making difficulty. African-American race was associated with more difficult decision-making.

Addition of treatment decision-making self-efficacy to the model reduced the effect of dispositional optimism on difficulty with decision-making by 32.5%, suggesting that self-efficacy partially mediated the effect of optimism on decision-making difficulty. The authors reported that 34% of patients claimed dissatisfaction with the decision-making process. In hierarchical multiple regression analysis, optimism explained 14%, and decision-making self-efficacy 12% of the variability in satisfaction.

These data suggest that education and modification of self-efficacy may help in the decision-making ability of patients low in optimism, and potentially improve their confidence in their ability to make decisions.

Orom H, Penner LA, West BT, Downs TM, Rayford W, Underwood W
Psychooncology. 2008 Sep 26. (Epub ahead of print)
doi:10.1002/pon.1385

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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