Patient-Provider Communication, Treatment, and Survival in a Population-Based Cohort: The North Carolina-Louisiana Prostate Cancer Project

Purpose Patient-provider communication (PPC) may be associated with receipt of definitive prostate cancer treatment and long-term outcomes. We examined these associations in a racially and geographically diverse population-based cohort. Methods We analyzed data for 2,258 Black and White participants enrolled in the North Carolina-Louisiana Prostate Cancer Project (2004-2009), with longitudinal vital status follow-up through 2020. PPC was measured using three subscales: contextual knowledge, communication content, and interpersonal treatment. We evaluated associations between PPC and receipt of definitive treatment and clinical outcomes. Results Communication content emerged as the most consistent PPC domain associated with clinical outcomes. Per five-point increase in communication content, the odds of receiving definitive treatment were higher for radiation therapy (odds ratio [OR], 1.49 [95% CI, 1.15 to 1.94]) and radical prostatectomy (OR, 1.73 [95% CI, 1.39 to 2.14]) compared with nondefinitive treatment. Communication content was also associated with greater likelihood of surgery within 3 months among prostatectomy recipients (OR, 1.66 [95% CI, 1.29 to 2.13]), with a directionally similar but nonsignificant association for radiation therapy. In competing-risk models, higher communication content was associated with lower prostate cancer–specific mortality (PCSM; subdistribution hazard ratio [sHR], 0.78 [95% CI, 0.61 to 0.99]). Associations varied by race and rurality, but formal interaction tests did not indicate effect measure modification. Conclusion We found that higher communication content scores were associated with higher receipt of definitive treatment, shorter time to surgery, and lower PCSM. These findings highlight communication as a potentially modifiable component of the patient-provider encounter. Communication based on high informational quality is associated with long-term prostate cancer outcomes and represents a candidate target for future intervention research to improve prostate cancer care delivery.