Masculinities and patient perspectives of communication about active surveillance for prostate cancer.

Objective: The purpose of this study is to describe connections between masculinities and patient perspectives of active surveillance (AS) related communication with male physicians.

Method: An interpretive descriptive qualitative design was used to explore patient-physician communication from the perspectives of 25 men on AS. In-depth, semistructured interviews were recorded, transcribed verbatim, and coded. Key concepts were described and a masculinities gender framework guided analyses of patients' perspectives.

Results: Patient-physician communication of diagnosis, treatment options, and specificities of AS featured prominently within participants' interviews. Most participants reported brevity in patient-physician communication amid accepting the physician's communication style and recommendations. Participants' accounts suggested "therapeutic" communications as contingent on positioning physicians as authoritative and assigning them control, while patients were stoic in accepting AS. However, some participants reported being confused about their diagnosis details and specific AS protocols, and resisted traditional physician-patient hierarchies, desiring more collaborative decision-making processes. In this regard communications emerged as "threat," in that participants lacked and/or lost confidence in their physician and were uncertain and anxious about the legitimacy of AS. These findings were interpreted within a gender framework, showing how patients drew on an array of masculine ideals, including stoicism, denying illness, and respecting expertise in different ways.

Conclusions: Our novel findings illuminate complexities of men's perspectives about patient-physician communication in AS, and offer insights about how masculinities influence what can be understood as potentially helpful and unhelpful communication among this emergent patient population.