Supporting men who choose active surveillance or active monitoring as a treatment option for localised prostate cancer: developing recommendations for clinical practice.

Rationale
Men newly diagnosed with localised prostate cancer face the dilemma of whether to choose potentially curative treatments (radical intervention such as surgery or radiotherapy) or a surveillance strategy (active surveillance or active monitoring -AM) with the option to treat if the cancer shows signs of progression. The treatments show no differences in terms of survival rates 10 years after diagnosis (Hamdy et al. 2016). Surgery and radiotherapy do not guarantee a cure but may adversely affect urinary, sexual or bowel function (Donovan et al. 2016). Active monitoring involves the risk of the disease progressing before curative treatment is started (Hamdy et al. 2016)
Little is known about what factors influence a man to follow an active monitoring pathway or switch to a radical treatment and what influence health care practitioners may have on these choices.

Aims & objectives
1. To conduct a systematic review of the literature on men’s and health care practitioners’ experiences of AM and what influences their decisions to continue with AM or switch to radical intervention.
2. To analyse face-to-face interaction during AM appointments to identify what factors influence treatment decision-making in clinic.
3. To consult patients and practitioners to identify patient needs and potential changes in practitioner practice which will optimise evidence based shared decision making during AM.

Methods
1. A systematic review of the literature on men’s and health care practitioners’ views on AM and influences on decisions to continue or switch to radical treatments.
2. Analysis of audio-recordings of active surveillance conducted in local clinics and/or active monitoring appointments already recorded during the ProtecT randomised controlled trial. A range of qualitative methods will be used including thematic analysis based on grounded theory and conversation analysis (e.g. see Wade et al. 2009)
3. To consult patients and health care practitioners using interviews and/or focus groups and/or questionnaires to understand what changes in AM practice may be beneficial to patients.
Depending on funding being available, it may be possible to build in a period of study with Assistant Professor Ida Korfage, an expert on decision making processes and quality of life, at Erasmus MC, Rotterdam, the Netherlands.