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1.
J Ren Nutr ; 2024 Jul 09.
Article in English | MEDLINE | ID: mdl-38992517

ABSTRACT

OBJECTIVE: In people with chronic kidney disease (CKD), hyperphosphatemia is an independent risk factor for mortality in observational studies. Despite not having proven benefit, dietary control of phosphorus is thought to be essential in CKD. Though dietary and serum phosphorus are correlated, ingested phosphate is less bioavailable from plant-foods rich in phytate than from animal and processed foods. Yogurt is considered a useful food due to its relatively low phosphorus and high protein content but may be detrimental since the protein content is from animal sources. Instead, plant-based yogurts (PBYs) may offer similar benefits without the associated downsides of animal protein in kidney disease, but little is known about the phosphorus contents of PBYs. DESIGN AND METHODS: Protein contents and phosphorus additives were obtained from nutrition labels of several, widely available PBYs of almond, cashew, oat, coconut, and soy substrates. Phosphorus content was measured via emission spectrometry by Eurofins (Madison, WI). Based on these data, phosphorus-to-protein ratio (PPR) for each PBY was calculated. RESULTS: Phosphorus was highest in Silk Soy Strawberry, then Silk Almond Strawberry and Siggi's Coconut Mixed Berries. Phosphorus was lowest in So Delicious Coconut Strawberry, then Oatly Oat Strawberry, Forager Cashew Strawberry, and Kite Hill Almond Strawberry. According to the ingredient labels, Silk Soy Strawberry, Silk Almond Strawberry, and Oatly Oat Strawberry contained phosphorus additives while Siggi's Coconut Mixed Berries contained pea protein additives. Of PBYs from the same substrate class, So Delicious Coconut Strawberry and Siggi's Coconut Mixed Berries had the largest differences in their phosphorus and protein contents. These seven samples' PPR ratios were higher than that of dairy yogurt values reported from the literature, including Stonyfield Organic Oikos Strawberry, Chobani Nonfat Strawberry, and Yoplait Greek Strawberry. CONCLUSION: Low phosphorus-to-protein ratio (PPR) foods are emphasized for people with CKD. Siggi's Coconut Mixed Berries had the lowest PPR. However, So Delicious Coconut Strawberry had the highest ratio which underscores product variability despite both using the same PBY substrate. Of the samples analyzed, Siggi's Coconut Mixed Berries may be the most desirable for patients with CKD because its PPR was the lowest.

2.
J Endourol ; 2024 Jul 13.
Article in English | MEDLINE | ID: mdl-39001821

ABSTRACT

INTRODUCTION: Kidney stones are common and morbid conditions in the general population with a rising incidence globally. Prior studies show substantial limitations of online sources of information regarding prevention and treatment. The objective of this study was to examine the quality of information about kidney stones from artificial intelligence (AI) chatbots. METHODS: The most common online searches about kidney stones from Google Trends and headers from the National Institute of Diabetes and Digestive and Kidney Diseases website were used as inputs to 4 AI chatbots (ChatGPT version 3.5, Perplexity, Chat Sonic, and Bing AI). Validated instruments were used to assess the quality (DISCERN instrument from 1 low to 5 high), understandability and actionability (PEMAT, from 0 to 100%) of the chatbot outputs. In addition, we examined the reading level of the information and whether there was misinformation compared to guidelines (5 point Likert scale). RESULTS: AI chatbots generally provide high-quality consumer health information (median DISCERN 4 out of 5) and did not include misinformation (median 1 out of 5). The median understandability was moderate (median 69.6%) and actionability was moderate to poor (median 40%). Responses were presented at an advanced reading level (11th grade; median Flesch-Kincaid score 11.3). CONCLUSIONS: AI chatbots provide generally accurate information on kidney stones and lack misinformation; however, it is not easily actionable and is presented above the recommended reading level for consumer health information.

3.
Curr Opin Urol ; 2024 Jun 03.
Article in English | MEDLINE | ID: mdl-38832408

ABSTRACT

PURPOSE OF REVIEW: We summarize the latest evidence regarding the impact of plant-based diets on urological and planetary health to facilitate patient counseling and research regarding dietary intervention. RECENT FINDINGS: Studies have highlighted the association of plant-based diets with a lower risk of multiple urological conditions including prostate cancer, erectile dysfunction, benign prostatic hyperplasia, and nephrolithiasis, as well as benefits for planetary health. SUMMARY: Plant-based diets are associated with numerous benefits that co-promote urological and planetary health.

4.
Article in English | MEDLINE | ID: mdl-38926606

ABSTRACT

BACKGROUND/OBJECTIVES: Patients often face uncertainty about what they should know after prostate cancer diagnosis. Web-based information is common but is at risk of being of poor quality or readability. SUBJECTS/METHODS: We used ChatGPT, a freely available Artificial intelligence (AI) platform, to generate enquiries about prostate cancer that a newly diagnosed patient might ask and compared to Google search trends. Then, we evaluated ChatGPT responses to these questions for clinical appropriateness and quality using standardised tools. RESULTS: ChatGPT generates broad and representative questions, and provides understandable, clinically sound advice. CONCLUSIONS: AI can guide and empower patients after prostate cancer diagnosis through education. However, the limitations of the ChatGPT language-model must not be ignored and require further evaluation and optimisation in the healthcare field.

5.
CA Cancer J Clin ; 2024 Jun 19.
Article in English | MEDLINE | ID: mdl-38896503

ABSTRACT

Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks-such as their extensive use and the relative ease it allows to share information quickly-facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give information prescriptions to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.

6.
BJUI Compass ; 5(6): 593-601, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38873351

ABSTRACT

Introduction: Although prostate magnetic resonance imaging (MRI) is commonly used in the diagnosis, staging and active surveillance of prostate cancer, little is known about patient perspectives on MRI. Methods: We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- and intermediate-risk prostate cancer managed with active surveillance. Interviews focused on experiences with and knowledge of prostate MRI and MRI-ultrasound fusion biopsy during active surveillance. We purposively sampled patients who received prostate MRI as part of their clinical care, conducted interviews until reaching thematic saturation and performed conventional content analysis to analyse data. Results: Twenty patients aged 51-79 years (mean = 68 years) participated in the study. At diagnosis, 17 (85%) had a Gleason grade group 1, and three (15%) had a grade group 2 tumour. Overall, participants viewed prostate MRI as a valuable tool that accurately localizes and monitors prostate cancer over time, and they considered prostate MRI central to active surveillance monitoring. We identified five thematic categories related to MRI use: (1) the experiential aspects of undergoing an MRI scan; (2) the experience of visualizing one's own prostate and prostate cancer; (3) adequacy of provider explanations of MRI results; (4) confidence in prostate MRI in decision-making; and (5) the role of prostate MRI in longitudinal follow-up, including an interest in using MRI to modify the timing of, or replace, prostate biopsy. Conclusion: Patients value prostate MRI as a tool that enhances their confidence in the initial diagnosis and monitoring of prostate cancer. This work can inform future studies to optimize patient experience, education and counselling during active surveillance for prostate cancer.

7.
JAMA Netw Open ; 7(5): e249053, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38691361

ABSTRACT

Importance: Plant-based diets are associated with many health and environmental benefits, including primary prevention of fatal prostate cancer, but less is known about postdiagnostic plant-based diet patterns in individuals with prostate cancer. Objective: To examine whether postdiagnostic plant-based dietary patterns are associated with risk of prostate cancer progression and prostate cancer-specific mortality. Design, Setting, and Participants: This longitudinal observational cohort study included men with biopsy-proven nonmetastatic prostate cancer (stage ≤T3a) from the diet and lifestyle substudy within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) enrolled at 43 urology practices across the US from 1999 to 2018. Participants completed a comprehensive diet and lifestyle questionnaire (including a validated food frequency questionnaire [FFQ]) between 2004 and 2016. Data were analyzed from August 2022 to April 2023. Exposures: Overall plant-based diet index (PDI) and healthful plant-based diet index (hPDI) scores were calculated from the FFQ. Main Outcomes and Measures: The primary outcome was prostate cancer progression (recurrence, secondary treatment, bone metastases, or prostate cancer-specific mortality). The secondary outcome was prostate cancer-specific mortality. Results: Among 2062 participants (median [IQR] age, 65.0 [59.0-70.0] years), 61 (3%) identified as African American, 3 (<1%) identified as American Indian or Alaska Native, 9 (<1%) identified as Asian or Pacific Islander, 15 (1%) identified as Latino, and 1959 (95%) identified as White. Median (IQR) time from prostate cancer diagnosis to FFQ was 31.3 (15.9-62.0) months after diagnosis. During a median (IQR) follow-up of 6.5 (1.3-12.8) years after the FFQ, 190 progression events and 61 prostate cancer-specific mortality events were observed. Men scoring in the highest vs lowest quintile of PDI had a 47% lower risk of progression (HR, 0.53; 95% CI, 0.37-0.74; P for trend = .003). The hPDI was not associated with risk of progression overall. However, among 680 individuals with Gleason grade 7 or higher at diagnosis, the highest hPDI quintile was associated with a 55% lower risk of progression compared with the lowest hPDI quintile (HR 0.45; 95% CI, 0.25-0.81; P for trend = .01); no association was observed in individuals with Gleason grade less than 7. Conclusions and Relevance: In this cohort study of 2062 men with prostate cancer, higher intake of plant foods after prostate cancer diagnosis was associated with lower risk of cancer progression. These findings suggest nutritional assessment and counseling may be recommended to patients with prostate cancer to help establish healthy dietary practices and support well-being and overall health.


Subject(s)
Diet, Vegetarian , Disease Progression , Prostatic Neoplasms , Humans , Male , Prostatic Neoplasms/pathology , Prostatic Neoplasms/mortality , Aged , Middle Aged , Longitudinal Studies , United States/epidemiology , Cohort Studies , Diet, Plant-Based
8.
Eur Urol Oncol ; 2024 May 17.
Article in English | MEDLINE | ID: mdl-38762369

ABSTRACT

BACKGROUND: Prostate cancer (PCa) diagnosis and treatment can have a significant negative impact on sexual health, affecting patients and their partners; however, the impact on partners is insufficiently addressed in current practice. OBJECTIVE: We describe the development and validation of an instrument to measure sexual health in female partners of patients with PCa. DESIGN, SETTING, AND PARTICIPANTS: Questions assessing sexual health were developed through a literature review, two qualitative studies, and an expert consensus process. Candidate survey items were tested through cognitive interviews and used to iteratively refine the questionnaire. INTERVENTION: The final questionnaire was tested in a validation study among 200 female partners. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We performed an exploratory factor analysis, followed by an analysis for internal validity, test-retest reliability, and convergent and discriminant validity. RESULTS AND LIMITATIONS: An initial set of 32 items was developed and refined through cognitive interviews. The resulting 27-item questionnaire was tested among 200 female partners of patients with PCa from across the USA. The exploratory factor analysis eliminated eight items and revealed seven key factors: (1) distress/satisfaction, (2) loss of connection as a couple, (3) active communication, (4) discomfort with communication, (5) frustration with sexual counseling, (6) expansion of sexual repertoire, and (7) nonpenetrative sexual activity. The overall scale demonstrated strong internal consistency (ordinal alpha 0.94) and test-retest reliability (0.89). Strengths of the study include development and evaluation of the first questionnaire to evaluate sexual quality of life among female partners of patients with PCa. However, additional work is needed to assess sexual health and quality of life among male and nonbinary partners. CONCLUSIONS: We developed a new instrument, the Sexual Concerns In Partners of Patients with Prostate cancer (SCIPPP-F), and found it to be valid in a diverse sample of female partners across the USA. PATIENT SUMMARY: Our new instrument can be used to characterize sexual health among female partners of patients with prostate cancer.

9.
Eur Urol Oncol ; 2024 Apr 29.
Article in English | MEDLINE | ID: mdl-38688768

ABSTRACT

Telemedicine, virtual conferences, and reducing waste in the operating room are ways in which urologists can reduce their environmental impact in daily practice. Patient counseling should also consider advice that simultaneously promotes overall, urological, and planetary health, such as plant-based diets and active transport.

11.
JCO Precis Oncol ; 8: e2300552, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38452310

ABSTRACT

PURPOSE: Germline genetic testing (GT) is important for prostate cancer (PCA) management, clinical trial eligibility, and hereditary cancer risk. However, GT is underutilized and there is a shortage of genetic counselors. To address these gaps, a patient-driven, pretest genetic education webtool was designed and studied compared with traditional genetic counseling (GC) to inform strategies for expanding access to genetic services. METHODS: Technology-enhanced acceleration of germline evaluation for therapy (TARGET) was a multicenter, noninferiority, randomized trial (ClinicalTrials.gov identifier: NCT04447703) comparing a nine-module patient-driven genetic education webtool versus pretest GC. Participants completed surveys measuring decisional conflict, satisfaction, and attitudes toward GT at baseline, after pretest education/counseling, and after GT result disclosure. The primary end point was noninferiority in reducing decisional conflict between webtool and GC using the validated Decisional Conflict Scale. Mixed-effects regression modeling was used to compare decisional conflict between groups. Participants opting for GT received a 51-gene panel, with results delivered to participants and their providers. RESULTS: The analytic data set includes primary outcome data from 315 participants (GC [n = 162] and webtool [n = 153]). Mean difference in decisional conflict score changes between groups was -0.04 (one-sided 95% CI, -∞ to 2.54; P = .01), suggesting the patient-driven webtool was noninferior to GC. Overall, 145 (89.5%) GC and 120 (78.4%) in the webtool arm underwent GT, with pathogenic variants in 15.8% (8.7% in PCA genes). Satisfaction did not differ significantly between arms; knowledge of cancer genetics was higher but attitudes toward GT were less favorable in the webtool arm. CONCLUSION: The results of the TARGET study support the use of patient-driven digital webtools for expanding access to pretest genetic education for PCA GT. Further studies to optimize patient experience and evaluate them in diverse patient populations are warranted.


Subject(s)
Genetic Counseling , Prostatic Neoplasms , Humans , Male , Genetic Counseling/methods , Genetic Testing , Germ Cells , Health Knowledge, Attitudes, Practice , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/genetics , Prostatic Neoplasms/therapy
12.
Eur Urol ; 2024 Mar 30.
Article in English | MEDLINE | ID: mdl-38556436

ABSTRACT

BACKGROUND AND OBJECTIVE: The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty. METHODS: A panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology. Panellists scored 193 statements using a 1-9 agreement scale, where 9 means full agreement. A summary of agreement, uncertainty, or disagreement (derived from the group median score) and consensus (determined using the Interpercentile Range Adjusted for Symmetry method) was calculated for each statement and presented for discussion before individual rescoring. KEY FINDINGS AND LIMITATIONS: Participants agreed that MRI scans must meet a minimum image quality standard (median 9) or be given a score of 'X' for insufficient quality. The current scan should be compared with both baseline and previous scans (median 9), with the PRECISE score being the maximum from any lesion (median 8). PRECISE 3 (stable MRI) was subdivided into 3-V (visible) and 3-NonV (nonvisible) disease (median 9). Prostate Imaging Reporting and Data System/Likert ≥3 lesions should be measured on T2-weighted imaging, using other sequences to aid in the identification (median 8), and whenever possible, reported pictorially (diagrams, screenshots, or contours; median 9). There was no consensus on how to measure tumour size. More research is needed to determine a significant size increase (median 9). PRECISE 5 was clarified as progression to stage ≥T3a (median 9). CONCLUSIONS AND CLINICAL IMPLICATIONS: The updated PRECISE recommendations reflect expert consensus opinion on minimal standards and reporting criteria for prostate MRI in AS. PATIENT SUMMARY: The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations are used in clinical practice and research to guide the interpretation and reporting of magnetic resonance imaging for patients on active surveillance for prostate cancer. An international panel has updated these recommendations, clarified the areas of uncertainty, and highlighted the areas for further research.

13.
Cancer ; 130(9): 1618-1628, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38348508

ABSTRACT

BACKGROUND: Plant-based diets have many health benefits, including a lower risk of fatal prostate cancer, and greater environmental sustainability. However, less is known regarding the impact of plant-based diets on quality of life among individuals diagnosed with prostate cancer. The authors' objective was to examine the relationship between plant-based diet indices postdiagnosis with quality of life. METHODS: This prospective cohort study included 3505 participants in the Health Professionals Follow-Up Study (1986-2016) with nonmetastatic prostate cancer. Food-frequency questionnaires were used to calculate overall and healthful plant-based diet indices. Quality-of-life scores were calculated using the Expanded Prostate Cancer Index Composite. Generalized estimating equations were used to examine associations over time between plant-based diet indices and quality-of-life domains (sexual functioning, urinary irritation/obstruction, urinary incontinence, bowel functioning, hormonal/vitality), adjusted for demographics, oncologic history, body mass index, caloric intake, health-related behaviors, and comorbidities. RESULTS: The median age at prostate cancer diagnosis was 68 years; 48% of patients underwent radical prostatectomy, and 35% received radiation as primary therapy. The median time from diagnosis/treatment to first the quality-of-life questionnaire was 7.0 years. A higher plant-based diet index was associated with better scores for sexual function, urinary irritation/obstruction, urinary incontinence, and hormonal/vitality. Consuming more healthful plant-based foods was also associated with better sexual and bowel function, as well as urinary incontinence and hormonal/vitality scores in the age-adjusted analysis, but not in the multivariable analysis. CONCLUSIONS: This prospective study provides supportive evidence that greater consumption of healthful plant-based foods is associated with modestly higher scores in quality-of-life domains among patients with prostate cancer.


Subject(s)
Cancer Survivors , Prostatic Neoplasms , Urinary Incontinence , Male , Humans , Aged , Prostate/pathology , Quality of Life , Prospective Studies , Follow-Up Studies , Diet, Plant-Based , Prostatic Neoplasms/pathology , Urinary Incontinence/epidemiology , Urinary Incontinence/etiology , Prostatectomy
14.
Health Educ Behav ; 51(3): 359-366, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38366884

ABSTRACT

Black men have a greater risk of prostate cancer as well as worse quality of life and more decisional regret after prostate cancer treatment compared to non-Hispanic White men. Furthermore, patients with prostate cancer who primarily obtain information on the internet have significantly more decisional regret compared to other information sources. Our objective was to explore the perspectives of Black patients on the use and impact of the internet for their prostate cancer care. In 2022-2023, we conducted seven virtual focus groups with Black patients with prostate cancer (n = 22). Transcripts were independently analyzed by two experienced researchers using a constant comparative method. Online sources were commonly used by participants throughout their cancer journey, although informational needs varied over time. Patient factors affected use (e.g., physical health and experience with the internet), and family members played an active role in online information-seeking. The internet was used before and after visits to the doctor. Key topics that participants searched for online included nutrition and lifestyle, treatment options, and prostate cancer in Black men. Men reported many downstream benefits with internet use including feeling more empowered in decision-making, reducing anxiety about treatment and providing greater accountability for research. However, they also reported negative impacts such as feeling overwhelmed or discouraged sorting through the information to identify high-quality content that is personally relevant, as well as increased anxiety or loss of sleep from overuse. In summary, online sources have the potential to positively impact the cancer journey by reinforcing or supplementing information from health care providers, but can be harmful if the information is poor quality, not representative, or the internet is overused.


Subject(s)
Black or African American , Focus Groups , Prostatic Neoplasms , Qualitative Research , Quality of Life , Humans , Male , Prostatic Neoplasms/therapy , Prostatic Neoplasms/psychology , Prostatic Neoplasms/ethnology , Black or African American/psychology , Middle Aged , Aged , Information Seeking Behavior , Internet Use , Internet
15.
J Urol ; 211(3): 376-383, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38329047

ABSTRACT

PURPOSE: Although the majority of US adults obtain health information on the internet, the quality of information about prostate cancer is highly variable. Black adults are underrepresented in online content about prostate cancer despite a higher incidence of and mortality from the disease. The goal of this study was to explore the perspectives of Black patients with prostate cancer on the importance of racial representation in online content and other factors influencing trust. MATERIALS AND METHODS: We conducted 7 virtual focus groups with Black patients with prostate cancer in 2022 and 2023. Participants completed an intake questionnaire with demographics followed by a group discussion, including feedback on purposefully selected online content. Transcripts were independently analyzed by 2 investigators experienced in qualitative research using a constant comparative method. RESULTS: Most participants use online sources to look for prostate cancer information. Racial representation is an important factor affecting trust in the content. A lack of Black representation has consequences, including misperceptions about a lower risk of prostate cancer and discouraging further information-seeking. Other key themes affecting trust in online content included the importance of a reputable source of information, professional website structure, and soliciting money. CONCLUSIONS: Underrepresentation of Black adults in prostate cancer content has the potential to worsen health disparities. Optimal online communications should include racially diverse representation and evidence-based information in a professional format from reputable sources without financial conflict.


Subject(s)
Digital Health , Prostatic Neoplasms , Trust , Adult , Humans , Male , Focus Groups , Black or African American
16.
BJUI Compass ; 5(1): 142-149, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38179031

ABSTRACT

Background: Tissue-based gene expression (genomic) tests provide estimates of prostate cancer aggressiveness and are increasingly used for patients considering or engaged in active surveillance. However, little is known about patient experiences with genomic testing and its role in their decision-making. Methods: We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- or favourable-intermediate-risk prostate cancer managed with active surveillance. We purposively sampled to include patients who received biopsy-based genomic testing as part of clinical care. The interview guide focused on experiences with genomic testing during patients' decision-making for prostate cancer management and understanding of genomic test results. We continued interviews until thematic saturation was reached, iteratively created a code key and used conventional content analysis to analyse data. Results: Participants' (n = 20) mean age was 68 years (range 51-79). At initial biopsy, 17 (85%) had a Gleason grade group 1, and 3 (15%) had a grade group 2 prostate cancer. The decision to undergo genomic testing was driven by both participants and physicians' recommendations; however, some participants were unaware that testing had occurred. Overall, participants understood the role of genomic testing in estimating their prostate cancer risk, and the test results increased their confidence in the decision for active surveillance. Participants had some misconceptions about the difference between tissue-based gene expression tests and germline genetic tests and commonly believed that tissue-based tests measured hereditary cancer risk. While some participants expressed satisfaction with their physicians' explanations, others felt that communication was limited and lacked sufficient detail. Conclusion: Patients interact with and are influenced by the results of biopsy-based genomic testing during active surveillance for prostate cancer, despite gaps in understanding about test results. Our findings indicate areas for improvement in patient counselling in order to increase patient knowledge and comfort with genomic testing.

17.
Nat Rev Urol ; 21(6): 329-338, 2024 06.
Article in English | MEDLINE | ID: mdl-38168921

ABSTRACT

Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared decision-making (SDM) can improve men's knowledge and reduce decisional conflict. SDM is supported by evidence, but can be difficult to implement in clinical settings. An inclusive definition of SDM was used in order to determine the prevalence of SDM in prostate cancer screening decisions. Despite consensus among guidelines endorsing SDM practice, the prevalence of SDM occurring before the decision to undergo or forgo prostate-specific antigen testing varied between 11% and 98%, and was higher in studies in which SDM was self-reported by physicians than in patient-reported recollections and observed practices. The influence of trust and continuity in physician-patient relationships were identified as facilitators of SDM, whereas common barriers included limited appointment times and poor health literacy. Decision aids, which can help physicians to convey health information within a limited time frame and give patients increased autonomy over decisions, are underused and were not shown to clearly influence whether SDM occurs. Future studies should focus on methods to facilitate the use of SDM in clinical settings.


Subject(s)
Decision Making, Shared , Early Detection of Cancer , Physician-Patient Relations , Prostatic Neoplasms , Humans , Prostatic Neoplasms/diagnosis , Male , Prostate-Specific Antigen/blood , Patient Participation
18.
Article in English | MEDLINE | ID: mdl-38172199

ABSTRACT

BACKGROUND: Germline testing is important in prostate cancer and evaluation can be complex. METHODS: We instituted a monthly multi-disciplinary virtual genetics tumor board (7/2021-3/2022). Participants and panelists were surveyed on usefulness and acceptability. RESULTS: 101 participants attended a session, and 77 follow-up surveys were completed. Over 90% participants and 100% panelists endorsed usefulness of the case discussions and usability of the technology. The majority felt it provided new information they will use. CONCLUSIONS: A multidisciplinary genetics board was successfully developed to address complexity in prostate cancer genetics. The virtual platform may enhance dissemination of expertise where there are regional gaps.

19.
PLoS One ; 19(1): e0290785, 2024.
Article in English | MEDLINE | ID: mdl-38266017

ABSTRACT

The Veterans Health Administration is chartered "to serve as the primary backup for any health care services needed…in the event of war or national emergency" according to a 1982 Congressional Act. This mission was invoked during the COVID-19 pandemic to divert clinical and research resources. We used an electronic mixed-methods questionnaire constructed using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation (COM-B) model for behavior change to study the effects of the pandemic on VHA researchers. The questionnaire was distributed electronically to 118 cancer researchers participating in national VHA collaborations. The questionnaire received 42 responses (36%). Only 36% did not feel that their research focus changed during the pandemic. Only 26% reported prior experience with infectious disease research, and 74% agreed that they gained new research skills. When asked to describe helpful support structures, 29% mentioned local supervisors, mentors, and research staff, 15% cited larger VHA organizations and 18% mentioned remote work. Lack of timely communication and remote work, particularly for individuals with caregiving responsibilities, were limiting factors. Fewer than half felt professionally rewarded for pursuing research related to COVID. This study demonstrated the tremendous effects of the COVID-19 pandemic on research activities of VHA investigators. We identified perceptions of insufficient recognition and lack of professional advancement related to pandemic-era research, yet most reported gaining new research skills. Individualizing the structure of remote work and ensuring clear and timely team communication represent high yield areas for improvement.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Veterans Health , Research Personnel , Medical Oncology
20.
Prostate Cancer Prostatic Dis ; 27(1): 153-154, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37491431

ABSTRACT

Podcasts represent a new source of information for patients and families dealing with prostate cancer, but no studies have been conducted evaluating the quality of information in them. Evaluating for: (1) quality based on the validated DISCERN criteria, (2) understandability and actionability based on the Patient Education Materials Assessment Tool (PEMAT), (3) misinformation, and (4) commercial bias, we concluded that podcasts are currently not good sources of information for lay health consumers.


Subject(s)
Health Literacy , Prostatic Neoplasms , Male , Humans , Teaching Materials , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Comprehension
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