Acceptability, understanding and experience of diagnostic tests for prostate cancer: a qualitative study with patients
Multiparametric MRI (mpMRI) is a new diagnostic test for prostate cancer, and is now recommended by NICE prior to prostate biopsy. Diagnostic accuracy studies show mpMRI can improve biopsy accuracy and avoid potentially unnecessary biopsies, but other important aspects of implementing mpMRI as a new diagnostic test have not been examined. There are no studies assessing acceptability of mpMRI for prostate cancer with any theoretical underpinning, and questions remain about men’s experience of undergoing the test and their understanding of the results. The aim of this study is to understand, from the perspective of patients, the acceptability of mpMRI as a diagnostic test for prostate cancer.
This qualitative study employed semi-structured interviews with men referred from primary care with suspected prostate cancer who have undergone mpMRI as part of their diagnostic work-up. Men were recruited from two hospital sites (Exeter and London), via outpatient ‘Two-Week Wait’ clinics. Interviews were conducted in-person or via telephone, and all were conducted by SM. They were audio recorded, and transcribed verbatim. A thematic analysis approach has been taken, both inductively by generating codes and themes from the data and deductively using Sekhon’s Theoretical Framework of Acceptability (TFA). The analysis team (SM, FW, and SA) discussed and refined the codes and themes to produce a thematic map, based on the early interviews. This study has ethical approval from the NHS Health Research Authority and the NHS South West – Frenchay Research Ethics Committee.
20 men have been interviewed for this study, with a range of ages (47-80 years) and geographical regions (10 urban; 10 rural); most have a white ethnic background (16 White British; 4 BME). Many men were philosophical about receiving a diagnosis of prostate cancer (“It is what it is”), although some felt it significantly impacted on their life and their health. mpMRI meets many of the constructs in Sekhon’s TFA. It has a low Burden and good Self-Efficacy (“It’s an easy test to take”), as well as high Intervention Coherence (“I think I knew pretty well what it was for”) and Perceived Effectiveness (“The MRI scan found some areas that were, let’s say, suspicious…”).
The new NICE recommendations do not specify whether mpMRI should be performed in primary or secondary care. Given the potential to reduce unnecessary prostate biopsies and the apparent acceptability of mpMRI to patients and clinicians, mpMRI could one day be used in primary care in the assessment of men with possible prostate cancer to reduce urgent urology referrals and avoid prostate biopsy complications. Financial, resource, and workforce implications for the NHS would need to be considered prior to GP access to mpMRI.