Thinking, Feeling, Choosing: How Affect Is Reflected in Prostate Cancer Treatment Decision Making—A Qualitative Study

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BACKGROUND: Shared decision-making (SDM) emphasizes informed, value-aligned choices, yet affect has not been a primary focus and is rarely addressed explicitly in cancer contexts. Among men with low-to intermediate-risk prostate cancer (LIRPC), active treatment and active surveillance each involve distinct affective challenges that may influence risk perception, decisional uncertainty, and treatment satisfaction. Despite prior work in affect and decision making literature, its integration into cancer contexts remains limited. AIMS: To address the gap, this study examined how affect, alongside cognition and psychosocial factors, was reflected in men's accounts of LIRPC treatment decision making, guided by SDM and affective science frameworks. METHODS: We conducted semi-structured interviews with 28 men with LIRPC across three treatment pathways: AS, AT, and AS-AT transition. Interviews were theory-informed and explored (a) how participants learned and interpreted diagnostic information; (b) how thoughts, emotions, and relationships were experienced in decision-making; and (c) how men reflected on preferred roles. Participants also completed the Control Preferences Scale. RESULTS: Eleven themes emerged across domains. Understanding of information depended on both the clarity of medical communication and its relational context. Participants described strong affective responses at diagnosis, awaiting test results, and shortly before surgery. Decision-making was often deliberative, with men weighing options alongside personal values and priorities, physician trust, and family support. Post-treatment reflections emphasized autonomy and value alignment, with coping used to manage affect and maintain a sense of control. CONCLUSIONS: In LIRPC decision-making, affect appeared to vary across contexts and time points. Although decisions were often described as deliberative, affect seemed embedded in how men interpreted information, navigated relationships, and defined what mattered (including quality of life, anticipated treatment outcomes, and autonomy), which influenced how options were weighed. Incorporating affect into decision support, particularly around key moments, may strengthen SDM and treatment satisfaction.

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