Introduction: Navigating prostate cancer treatment decisions can be challenging for patients. Exploring patient perceptions provides valuable insight into patients' experiences, informing a better understanding of their needs and delivering more holistic, patient-centred care. This convergent mixed-methods study investigated patient perceptions and recall of treatment specifics, whilst exploring their decision-making preference, health literacy and decision regret.
Methods: Patients diagnosed with prostate cancer and referred for radiation therapy at an Australian regional centre between 2019 and 2025 were invited to complete a survey, including: demographics, patient recall, treatment regret, decision-making preference, health literacy status, and patient perspectives. Thematic analysis of perspectives was completed from free-text comments. Kappa statistics were used to compare recall responses to their medical records. A sample size of 80 was calculated for quantitative analysis, and data saturation was achieved for qualitative analysis.
Results: 160 participants responded, 149 participants (93%) provided free-text comments and 125 participants (78%) consented for medical record comparison. Overall, recall was good to excellent except for fair to poor recall of hormone therapy (κ:0.59, CI: 0.45-0.73), transperineal ultrasound (κ:0.3, CI: 0.12-0.48) and magnetic resonance linear accelerator (κ:0.24, CI: 0.04-0.44). The most common decision-making preference was patient-led with input from the doctor (48%), 54% reported adequate health literacy, and 19% had strong decision regret. Thematic analysis of free-text comments established five key themes: (1) Interactions with staff members, (2) Treatment experience/outcome, (3) Accessibility to services, (4) Decision-Making preference and (5) Treatment regret.
Conclusion: Participants valued the right to make their own decisions with input from health professionals; however, inadequate health literacy could act as a barrier to making informed decisions, potentially leading to decision regret. Poorer recall of hormone therapy, transperineal ultrasound and magnetic resonance linear accelerator require further investigation with need for improved education. Continuously personalising shared decision-making practices will improve patient experience and understanding.