Barriers and enablers of active surveillance for prostate cancer: a qualitative study of clinicians

What is it about?

This study aimed to identify barriers and enablers of active surveillance (AS) for low-risk prostate cancer (LRPCa) from the perspective of clinicians. Urologists and radiation oncologists in Australia and New Zealand were interviewed. Three broad themes emerged: (i) clinician perception of patients' barriers and enablers; (ii) clinician perception of their own barriers and enablers; and (iii) engagement with healthcare team and resource availability. All interviewees supported AS but many overestimated its incidence. Clinicians' perception of the psychological burden of PCa may be a barrier to implementing AS. Limited time, poor communication and remote locations were identified as significant barriers. The study recommends improving patient counselling, alternative care models and increasing remoteness access to increase AS uptake.

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Why is it important?

Identifying barriers and enablers of active surveillance (AS) for low-risk prostate cancer (LRPCa) is important for improving patient outcomes and reducing unnecessary treatments. Understanding the decision-making process of clinicians regarding AS can help in developing strategies to increase access to AS and improve patient care. Key Takeaways: 1. Clinician perception of patients' and their own barriers and enablers, as well as engagement with the healthcare team and resource availability, affect the decision-making process regarding AS for LRPCa. 2. Poor communication, anxiety, and lack of trust in the clinical team can be barriers to AS. Improving patient counseling, promoting validated tools, and implementing alternative care models can help mitigate these barriers. 3. Remoteness, ambiguity in inclusion and surveillance criteria, and defensive medicine are potential barriers to AS. Strategies to address these barriers include increasing access to local AS in remote areas, standardizing protocols, and improving communication between clinicians and patients.