Shared treatment decision-making between physicians and their patients with metastatic urothelial carcinoma: Results of a real-world survey in Europe and the United States.

e16581 Background: Metastatic urothelial carcinoma (mUC) is associated with poor prognosis, but recent treatment (tx) approvals have changed the therapeutic landscape. Patient (pt) involvement in cancer tx decisions has been shown to improve quality of life and support informed consent. However, there is a paucity of data on pt involvement in tx decisions for mUC. We aimed to address this data gap by exploring the concordance between pt- and physician-reported pt involvement in mUC tx decisions. Methods: Data were drawn from the Adelphi Real World mUC Disease Specific Programme, a cross-sectional survey of medical oncologists/urologists and their pts with mUC in Europe and the US, from Dec 2023 to Jul 2024. Physicians reported pt demographics and pt involvement in mUC tx decision-making. Pts voluntarily reported their involvement in tx decision-making. Alignment on pt involvement was measured between matched response options from pts and physicians using a weighted Cohen’s κ coefficient, with level of concordance categorized using the Landis and Koch (1977) scale. Results: Overall, 100 physicians reported data for 452 pts with mUC who provided details on their involvement in tx decisions. Mean (SD) pt age was 68.7 (8.2) years; most pts were male (69%) and White (97%) and had a caregiver (69%). Only 18% of pts reported being involved in the final tx decision in some way, ranging from 10% in Spain (n = 11/106) to 33% in the UK (n = 9/27). In contrast, physicians reported that 42% of pts were involved in the tx decision in some way, ranging from 33% in Spain (n = 35/106) to 48% in Italy (n = 32/66) and the UK (n = 13/27). Across the 335 pts with matched pt-physician responses, concordance on pt involvement in the tx decision was moderate (κ = 0.4621). Most commonly, 61% of pts (n = 206) reported that they discussed all tx options with the physician, but the physician made the final decision. For these pts, 77% of their physicians (n = 159) agreed exactly. A fifth of pts (20% n = 68) reported that their physician made the tx decision with no input from them. For these pts, 50% of their physicians (n = 34) agreed exactly, and 38% of their physicians (n = 26) reported discussing the tx options with the pt but said that the physician made the final decision themselves. Overall, exact agreement between pts and physicians on pt involvement was observed for 69% of pts. Conclusions: Despite just under half of physicians reporting that the pt was involved in the tx decision, only 1 in 5 pts reported the same. This discordance between physicians and pts highlights the need to strengthen existing pt-physician relationships, to move toward a shared decision-making model and facilitate true informed consent. With the expansion of tx options, each with distinct benefit-risk profiles, supporting pts with mUC to take an active role in their tx is important to ensure clinical and personal goals are met.