The majority of the studies included in this review used a qualitative approach. Such methods explore a topic area in-depth and provide a descriptive account of findings. While this approach can provide very rich data in specific domains, these data are not intended to be generalisable. Thus, quantitative studies (preferably with prospective designs) are required in the future to ascertain, not only the salient beliefs influencing treatment choices but also, how these beliefs affect long-term adjustment to the disease and its treatment.
With regards to the studies which employed quantitative methodologies, none used standardised and validated measures for examining illness or treatment beliefs. Two of the quantitative studies [32, 34] developed their measures of beliefs from previous published work. The remaining study developed its measure from preliminary focus groups and interviews . It could be suggested that further validation of these measures is required before any strong conclusions can be drawn.
The time at which illness and treatment beliefs were measured is another shortcoming of the included studies. Some of the studies included those patients who had already made a treatment decision or who had already started treatment. This may have affected the reliability of the findings due to the potential bias of patients recalling what they believed about their illness and its treatment at these times in the treatment process. Prospective designs involving the assessment of beliefs before a treatment choice is made would offer a more robust approach.
A further limitation concerned the majority of the patient samples being predominantly white and from North America. Therefore, the experiences of other groups, such as men of Afro-Caribbean origin in whom the risk of prostate cancer is greater, were not represented. Further research is required across a range of ethnic and cultural groups.
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