Sains Malaysiana 45(6)(2016): 941–947

Doctors' Approaches to Decision Support in Counseling Patients with Localized Prostate Cancer: An Asian perspective

(Pendekatan Doktor untuk Menyokong Keputusan dalam Memberi Kaunseling kepada

Pesakit Kanser Prostat Setempat: Perspektif Asia)

AI THENG CHEONG¹*, PING YEIN LEE¹, CHIRK JENN NG², YEW KONG LEE², TENG AIK ONG³, KHATIJAH LIM ABDULLAH⁴ & AZAD HASSAN ABDUL RAZACK³

¹Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia

²Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia

³Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai,  50603 Kuala Lumpur, Malaysia

⁴Department of Nursing Science, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia

Diserahkan: 28 September 2015/Diterima: 16 Disember 2015

ABSTRACT

There are many treatment options for localized prostate cancer, and there is clinical equipoise in relation to the treatment outcomes. This study aimed to explore doctors’ approaches to decision support in counseling patients with localized prostate cancer in a country with a less established system of support and care delivery for cancer treatment. Four in-depth interviews and three focus group discussions were conducted with seven government policy makers/consultant urologists, three oncologists, four private urologists and six urology trainees in Malaysia between 2012 and 2013. Doctors facilitated the treatment decision by explaining about the disease and the treatment options, which included monitoring, side effects and complications of each treatment option. Paper-based (charts and diagram drawings) or electronic (ipad apps and websites) illustrations and physical models were used as patient education aids. Further reading materials and websites links were often provided to patients. Patients were given time till subsequent follow up to decide on the treatment and family involvement was encouraged. Referral to other healthcare professionals (oncologist, radiotherapist or other urologist) for second opinion was offered to the patients. The doctors would recommend patients to speak to prostate cancer survivors for peer support but official support groups were not easily accessible. This study highlighted a multi-faceted approach to support patients with localized prostate cancer in making a treatment decision. It not only involved the doctors (urologist or oncologist) themselves, but also empowered the patients and their social network to support the decision making process.

Keywords: Decision making support; prostate cancer; qualitative; treatment

ABSTRAK

Terdapat banyak pilihan rawatan untuk kanser prostat setempat, dan terdapat soal keseimbangan faedah klinikal berhubung dengan pelbagai hasil rawatan. Kajian ini bertujuan untuk meneroka pendekatan doktor dalam menyokong pesakit kanser prostat setempat untuk membuat keputusan rawatan semasa kaunseling di negara yang kekurangan sistem sokongan yang mantap untuk rawatan kanser. Empat temu bual mendalam dan tiga kumpulan perbincangan fokus telah dijalankan dengan tujuh orang penggubal dasar kerajaan/perunding urologi, tiga orang pakar onkologi, empat orang pakar urologi swasta dan enam orang pelatih urologi di Malaysia antara tahun 2012 dan 2013. Doktor memudahkan keputusan rawatan dengan menjelaskan mengenai penyakit tersebut dan pilihan rawatan, di mana ia termasuk cara pemantauau, kesan sampingan dan komplikasi setiap pilihan rawatan. Ilustrasi berasaskan kertas (carta dan lukisan rajah) atau elektronik (aplikasi ipad dan laman web) dan fizikal model telah digunakan sebagai alat bantuan pendidikan pesakit. Bahan-bahan bacaan lanjut dan laman web pautan sering diberikan kepada pesakit. Pesakit telah diberi masa sehingga susulan berikutnya untuk membuat keputusan mengenai rawatan dan penglibatan keluarga adalah digalakkan. Rujukan kepada profesional kesihatan yang lain (pakar onkologi, radioterapi atau pakar urologi yang lain) bagi memperolehi pendapat kedua telah ditawarkan kepada pesakit. Para doktor akan mengesyorkan pesakit untuk berbual dengan bekas pesakit kanser prostat untuk mendapat sokongan rakan sebaya tetapi kumpulan sokongan rasmi tidak mudah didapati. Kajian ini menekankan pendekatan yang pelbagai untuk menyokong pesakit kanser prostat dalam membuat keputusan rawatan. Ia bukan sahaja melibatkan doktor (pakar urologi atau pakar onkologi) diri mereka sendiri, tetapi juga menggalakkan pesakit sendiri dan rangkaian sosial mereka untuk menyokong proses membuat keputusan.

Kata kunci: Kanser prostat; kualitatif; rawatan; sokongan membuat keputusan

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*Pengarang untuk surat-menyurat; email: cheaitheng@upm.edu.my