The decision on a treatment modality for LPCa could, therefore, be described as a challenging one requiring patients to weigh up a range of physical and psychological outcomes of treatments. Indeed, it has been shown that patients can experience decision-related distress at diagnosis, which can persist over time and lead to poorly informed treatment decisions . The difficulties associated with making a treatment choice can be further magnified by patients making their decisions based on their personal beliefs. These personal beliefs can help patients construct a mental representation about their disease and its treatment, which can guide their adjustment to their disease. Such beliefs are of particular importance to treatment decisions when there is great uncertainty around the long-term effects of treatment.
Extensive research has found that personal beliefs can predict a range of outcomes, including quality of life, help-seeking behaviour and treatment adherence [16-18]. These beliefs have also been shown to affect treatment choice, mainly by way of selecting between conventional treatment and complementary and alternative medicines (CAM) for conditions, such as chronic pain, hypertension, and both localised and advanced prostate cancer [19-22]. These studies reported that patients who used CAM were more likely to hold negative beliefs about their illness (i. e. , that their illness was chronic and that they had little personal control over its management); and about conventional treatments (i. e. , believed the treatments would result in significant undesirable side-effects). In contrast, patients who were less likely to favour CAM held positive beliefs about their illness and its treatment (i. e. , believed the condition was not severe and would easily be controlled with conventional treatment). Indeed, patients' positive beliefs about their illness were also shown to increase the likelihood of choosing generic rather than branded medicines, as well as reduce the amount of drugs they consumed to manage their conditions [20, 23].
It is not well-understood how patients, who are diagnosed with LPCa and offered conventional treatments, make sense of their disease and their treatment decisions through examining personal beliefs. Patients with LPCa can make treatment decisions that may not necessarily be in accordance with the treatment-related information provided by urologists . Thus, patients may choose a treatment based on confounding information derived from their own experience and from other sources available to them. By gaining a better understanding of patients' personal beliefs may help both patients and urologists make more informed decisions about treatments.
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