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首页> 外文期刊>BJU international >Psychosocial barriers to active surveillance for the management of early prostate cancer and a strategy for increased acceptance.
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Psychosocial barriers to active surveillance for the management of early prostate cancer and a strategy for increased acceptance.

机译：积极监测早期前列腺癌管理的社会心理障碍和增加接受度的策略。

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OBJECTIVES To review the psychosocial needs of men undergoing active surveillance (AS, the monitoring of early prostate cancer, with curative intervention only if the disease significantly progresses) for prostate cancer, and barriers to its uptake. METHODS The introduction of screening for prostate-specific antigen (PSA) has led to more men diagnosed with early and nonlife-threatening forms of prostate cancer; about half of men diagnosed as a result of PSA testing have cancers that would never cause symptoms if left untreated and yet up to 90% of such men receive curative therapy, then living with the toxicity of treatment but with no benefit. Thus AS is increasingly being promoted, but if such a strategy is to succeed, the psychosocial barriers that discourage men from adopting AS must be addressed. We reviewed and assessed reports on this topic, published in English since 1994. RESULTS There is relatively little research on AS, as most published reports refer to watchful waiting (which is a palliative management approach). Men with prostate cancer generally have lower levels of psychological disturbance than for other cancers, but the psychosocial issues identified include anxiety in response to no intervention, uncertainty related to loss of control, and lack of patient education and support, particularly around the time of initial treatment planning. Approaches that were identified to improve uptake of AS include increased education and improved communication, interventions to reduce anxiety and uncertainty, and the empowerment of patients by the development of a sense of control and meaning. Physicians attitudes are influential and the education of physicians about AS as an appropriate option is to be encouraged. Peer-support groups were also identified as being of particular value. CONCLUSIONS There are several strategies that should be developed if AS is to become more widely adopted. Increased education and good communication can alleviate anxiety and uncertainty, as can interventions for cognitive re-framing. Inviting patients to become active participants in their management might enhance the patients' sense of control, and the involvement of peer-support groups might be beneficial.
机译：目的回顾接受主动监测（AS，对早期前列腺癌的监测，仅在疾病显着进展时进行治疗性干预）的男性对前列腺癌的社会心理需求，以及其摄取障碍。方法筛查前列腺特异性抗原（PSA）的方法导致更多男性被诊断出患有早期且无生命危险的前列腺癌。大约有一半的通过PSA测试被诊断出的男性患有癌症，如果不及时治疗，它们永远不会引起症状，但是，高达90％的男性接受了根治性治疗，但仍具有治疗的毒性，但没有益处。因此，越来越多的人推广AS，但是如果要成功实施这种策略，就必须解决阻碍男性采用AS的心理社会障碍。我们审查并评估了有关该主题的报告，该报告自1994年以来以英文发布。结果关于AS的研究相对较少，因为大多数已发布的报告都涉及警惕的等待（这是一种姑息性管理方法）。与其他癌症相比，前列腺癌患者的心理障碍水平通常较低，但是已发现的社会心理问题包括对无干预措施的焦虑，与失控相关的不确定性以及缺乏患者的教育和支持，尤其是在初次就诊期间治疗计划。已确定的改善AS吸收的方法包括加强教育和改善沟通，减少焦虑和不确定性的干预措施以及通过发展控制感和意义赋予患者权力。医师的态度具有影响力，应鼓励医师对AS作为适当的选择进行教育。同行支持小组也被认为具有特殊价值。结论如果要更广泛地采用AS，应制定几种策略。教育程度的提高和良好的沟通可以减轻焦虑和不确定性，认知重塑的干预措施也可以减轻焦虑和不确定性。邀请患者积极参与治疗可能会增强患者的控制感，同伴支持小组的参与可能是有益的。

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