TABLE 2.

Illustrative quotes extracted from transcripts

Partner support and direct influence on treatment choice

Partner support and influences on the patient and the decision. “I have to be sensitive to her feelings as well. We've been married 38 years already … So we have always come to some kind of decision together or at least we try to accept each other's opinion. And, and it was important to me that she accept why I wanted to do this and understood it, and I think she finally did.” Participant 1008, Patient, AS. Partner disagreement about treatment choice. “I'm feeling the same thing that, what I've always heard, with cancer, you need to take care of it, you know, time is the essence. You take care of it fast, and you do whatever you can to get rid of it. And to me, it's like surgery. That's where the cancer is. You get rid of the prostate, and you are done. Um, but for him, it wasn't that, you know, that clear‐cut process. So it's been a little frustrating for me, because we are really not on the same page as far as how we'd approach treatment” Participant 2017, Partner. “My wife actually had a very strong opinion and, and we were surprisingly once again on different sides of the table about it. And it wasn't until she came around to my side, which made my decision a lot easier because then I knew that she was supportive and understood it.” Participant 1008, Patient, AS.

Patient and partner vicarious experiences may influence treatment decision

“I've heard cases from all extremes, as I'm sure you all have. I've heard cases of, ‘[the prostatectomy] was no problem. I did it and within two months I was fine and I'm so glad I did it’. And I've heard other cases of people who years later are still dealing with the side effects and have said, ‘I would never do it again’. I've heard both experiences.” Participant 1002, Patient, AS. “I will not say it's the sole reason, but it's one of the main reasons that I made the decision to do the surgery. I just looked at it and said, you know what? I do not know that I can go day‐to‐day and not know, okay, what if it progresses and it steps out of the host organ, and all of a sudden, now I'm like my brother where he was sick and let it go and let it go and let it go, and then he all of a sudden was faced with a stage four advanced disease that there was nothing he could do about it.” Participant 1207, Patient, Prostatectomy. “I guess I always thought because I had a close friend of mine that had prostate cancer and he had surgery that I always thought in the back of my mind that that was the option I would take.” Participant 1138, Patient, Prostatectomy.

The influence of the external circumstances

“The biggest difficulty for me is that my wife has not been available for me … The problem was I got diagnosed at a time when my wife is out of the country, she's working overseas … The biggest problem I have in dealing with the whole thing is not the condition itself, but how I was going to let my wife know about it” Participant 1021, Patient, AS. “[If] they told me that there would not be really any side effects to the surgery I would have had it taken out already … At my age I cannot, I cannot live with the incontinence … I'm working and I just cannot live with it.” Participant 1010, Patient, AS.

Disclosure to wider social networks: friends, family, co‐workers

Disclosing can increase support and normalise the situation “Then when you find out how many people are indeed experiencing the same thing … then it becomes a big support network and I think that's extremely helpful as well because you, you each share information as you learn new things, because you cannot obviously catch everything that's out there in the world and … now you are getting your friends letting you know, hey, do you know about this? Have you heard about that?” Participant 1008, Patient, AS. Disclosing is not always seen as necessary “I internalized a lot of it. That's just the way that I am. I do not like to worry [people], even as close as my wife and my children. I initially just kept it from them to be honest with you. I mean I let my wife know right out of the gate. I think I called her as soon as I got into the parking lot. But for example, my mother to this day does not know. She's just elderly and she has some health issues herself… I do not feel that it's necessary for her to even know about it at this point … I really did not tell a lot of people before my wife initially and that's just the way that I function, I guess. I try to resolve things. I do not like to worry other people until I know exactly what's going on.” Participant 1127, Patient, AS.

The importance of a good relationship and experience with physicians
Positive experiences increase confidence “He comes across as very confident, competent, knowledgeable, and just makes me—gave me a confidence level that for now I do not need to worry. See you in six months.” Participant 1002, Patient, AS. Negative experiences cause stress and anxiety “I felt that initially out of the gate at the initial urologist I was not given any information whatsoever. And that added to a lot of my stress. I can understand why some people may not want to know. To be honest with you, I understand it, but that's not how I–that's not my process.” Participant 1127, Patient, AS.
Seeking a second opinion can assist decision‐making “I have a lot of friends that went through different types of cancer, not only prostate cancer, but also other kinds of cancer. So obviously you are familiar with the facility. You're familiar with their reputation. You're getting word of mouth as far as the quality and it is where you want to be. I feel confident going there.” Participant 1127, Patient, AS.

Learning about PCa and treatments

Learning about PCa and treatments is essential, but sometimes overwhelming “I felt there was enough information out there. And at times, there's almost too much information. Okay, I know what I know. And there always seems to be another piece of information you can find. And at some point, you just have to cut the turmoil and say, I'm going to make a decision on what I know … Sometimes it's too much. Sometimes it absolutely can be too much information.” Participant 1034, Patient, Prostatectomy. Information sources used “I did not want to read the nonsense and the noise that would be on the Internet. I tried to find good articles and good data to help me make the decision.” Participant 1245, Patient, Prostatectomy. “Well there's just so much news out there. There's been so many, you know, famous people what have had it, um, that, you know, immediately I went on the web and started reading about, you know, their stories.” Participant 1014, Patient, AS.

Weighing up the risks and benefits of the treatment options

Avoiding the side effects of definitive treatments “That was really the main concern about why I'm leaning towards active surveillance right now, because I'm 55 years old, I'm young – in my mind I'm young – and things are fine physically, so why should I – why do I risk complications when nothing's really a problem right now” Participant 1021, Patient, AS. Making a treatment decision can take time “There are so many options, and it's almost like there are too many options. I almost wish it was more cut and dry, and the doctor would say this is the way to do it, and this is the best way, the only way, and you have to do it now. Um, the fact that there are so many options and so many opinions, and that you have time … it gets very confusing.” Participant 2017, Partner. Strong desire to remove or treat the cancer “I thought that the term active surveillance was kind of marketing bullshit, frankly. Let us, let us sit and wait and hope nothing bad happens. And, and I guess that's a philosophy that I cannot ever embrace. For me, it was like saying, oh, I have a hole in my roof. Let us not repair it now. Let us repair it in ten years and hope it does not get any worse. That's not, that's not who I am.” Participant 1348, Patient, Prostatectomy.