Mp12-12 Physician Preferences Regarding Communication of Life Expectancy in Prostate Cancer Treatment Consultations

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (MP12)1 May 2024MP12-12 PHYSICIAN PREFERENCES REGARDING COMMUNICATION OF LIFE EXPECTANCY IN PROSTATE CANCER TREATMENT CONSULTATIONS John R. Heard, Antwon Chaplin, Dmitry Khodyakov, Brennan Spiegel, Stephen Freedland, and Timothy Daskivich John R. HeardJohn R. Heard , Antwon ChaplinAntwon Chaplin , Dmitry KhodyakovDmitry Khodyakov , Brennan SpiegelBrennan Spiegel , Stephen FreedlandStephen Freedland , and Timothy DaskivichTimothy Daskivich View All Author Informationhttps://doi.org/10.1097/01.JU.0001009376.16371.fb.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While guidelines endorse specific life expectancy (LE) cutoffs for consideration of conservative management of prostate cancer (PC), overtreatment of men with limited LE persists in the active surveillance era. We previously found that patients have a strong preference for communication of quantitative estimates of LE but that physicians often omit or generalize LE information in consultations. We sought to determine physician preferences regarding LE communication and to identify barriers to incorporating LE into treatment decisions. METHODS: We conducted semi-structured interviews of 15 physicians who regularly counsel men with PC. We asked questions about physician-level barriers to communication of LE to patients, confidence in LE estimates, and preferred mode of LE communication. Interviews were transcribed verbatim and coded for thematic content using an open coding approach. Saliency analysis was used to describe emergent themes. RESULTS: Our analytic sample included 6 urologists, 5 radiation oncologists, and 4 medical oncologists. Physician-level barriers to communication of LE included concerns about patient receptiveness (67%), imprecision of LE estimates (40%), and loss of patient trust (27%). There was significant heterogeneity in the sources of information used to calculate LE, with 40% using a gestalt method, 33% using life tables, and 20% using nomograms. The preferred mode of communication varied widely among physicians, with 40% preferring a probability at a timepoint, 33% a generalization, and 27% a number of years. The vast majority of physicians had low (40%) or moderate (53%) confidence in LE predictions, due to high variability in estimates (53%) and inapplicability to individuals (27%). To improve confidence in estimates, physicians wished for a readily available, validated prediction tool (40%), reporting of variability of LE estimates (33%), and molecular/genetic biomarkers (27%). CONCLUSIONS: We identified significant heterogeneity in physician beliefs around communicating LE that may contribute to overtreatment. A third of physicians preferred to communicate LE as a generalization, which conflicts with patient preferences for numeric data. The most common method for calculating LE was the gestalt method, which is less accurate than evidence-based methods. Barriers to physician LE communication included concerns about patient receptiveness and perceived imprecision of LE estimates. Addressing these concerns will be essential to improving LE communication and ultimately reducing overtreatment. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e205 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information John R. Heard More articles by this author Antwon Chaplin More articles by this author Dmitry Khodyakov More articles by this author Brennan Spiegel More articles by this author Stephen Freedland More articles by this author Timothy Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...