Patient Participation in Consultations for Clinically Localized Prostate Cancer

No AccessJournal of UrologyOriginal Clinical Article10 Oct 2025Patient Participation in Consultations for Clinically Localized Prostate Cancer Paul Kokorowski, MD, MPH Nadine A. Friedrich, MD Michael Luu, MPH Alex Shiang, Sanjay Das, James Daniels, Stephen J. Freedland, MD Brennan Spiegel, andMD Timothy J. DaskivichMD, MSHPM Paul KokorowskiPaul Kokorowski Departments of Urology and Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA , Nadine A. FriedrichNadine A. Friedrich Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA Urology Section, Department of Surgery, Veterans Affairs Health Care System, Durham, NC , Michael LuuMichael Luu Biostatistics and Bioinformatics Core, Cedars-Sinai Medical Center, Los Angeles, CA , Alex ShiangAlex Shiang Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA , Sanjay DasSanjay Das Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA , James DanielsJames Daniels Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA , Stephen J. FreedlandStephen J. Freedland Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA Urology Section, Department of Surgery, Veterans Affairs Health Care System, Durham, NC Center for Integrated Research in Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA , Brennan SpiegelBrennan Spiegel Cedars-Sinai Center for Outcomes. Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA , and Timothy J. DaskivichTimothy J. Daskivich Corresponding Author: Timothy J. Daskivich, Samuel Oschin Comprehensive Cancer Center Department of Urology, Cedars-Sinai Medical Center, 8635 W Third St #1070W, Los Angeles, Ca, P: 310-423-4700, E: (email protected) View All Author Informationhttps://doi.org/10.1097/JU.0000000000004814AboutPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Shared decision making (SDM) for prostate cancer treatment requires active participation of patients and providers. While the physician's role has been studied extensively, the patient's role in SDM is poorly characterized. We sought to describe variation in patient participation and thematic content during consultations for localized prostate cancer. Materials and Methods: 6,601 patient statements from 50 multispecialty consultations across 10 providers were analyzed for content and speech type using an open coding approach and then categorized into major themes. The proportion of patient words, statement types, and counts of statements described content. We used a Generalized Linear Mixed Model (GLMM) to identify predictors of words spoken, questions asked, and words related to SDM including sociodemographic data, decisional conflict score (DCA), and autonomy preference index scores (API). Results: Patients speech comprised a median of 19.9% (IQR 12.7%, 32.3%) of total words per consultation, with a broad range (1.8% to 51.1%). Coders identified 5 primary types of speech segments: Acknowledgements (27.7% of patient quotes), Expressions/Preferences (8.8%), Questions/Requests, (21.5%), Providing information (34.5%), and other (7.6%). There was a median of 18.5 (IQR 9, 32) patient questions per consultation, with a broad range (3 to 128). The median proportion of patient speech related to SDM (i.e. treatment preferences, treatment values, or decision-making process) was 3.4% (IQR 1.85%-6.74%). In multivariable models, only tumor risk was associated engagement in SDM (IRR 2.43, 95%CI 1.17-5.01 for favorable and IRR 2.23, 95%CI 1.11-4.47 for unfavorable/high), while otherwise there were no significant predictors of the number of patient words, questions asked, or statements related to SDM. Conclusions: Patient participation in prostate cancer consultations was highly variable, with no consistent predictors. Minimal time is spent expressing preferences, values, or the decision-making process. Providers should adjust practices to ensure adequate participation, specifically prioritizing elicitation of values and preferences. © 2025 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2025 by American Urological Association Education and Research, Inc.Keywordsprostate cancermultidisciplinary treatment consultations. Author Information Paul Kokorowski Departments of Urology and Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA More articles by this author Nadine A. Friedrich Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA Urology Section, Department of Surgery, Veterans Affairs Health Care System, Durham, NC More articles by this author Michael Luu Biostatistics and Bioinformatics Core, Cedars-Sinai Medical Center, Los Angeles, CA More articles by this author Alex Shiang Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA More articles by this author Sanjay Das Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA More articles by this author James Daniels Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA More articles by this author Stephen J. Freedland Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA Urology Section, Department of Surgery, Veterans Affairs Health Care System, Durham, NC Center for Integrated Research in Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA More articles by this author Brennan Spiegel Cedars-Sinai Center for Outcomes. Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA More articles by this author Timothy J. Daskivich Corresponding Author: Timothy J. Daskivich, Samuel Oschin Comprehensive Cancer Center Department of Urology, Cedars-Sinai Medical Center, 8635 W Third St #1070W, Los Angeles, Ca, P: 310-423-4700, E: (email protected) More articles by this author Expand All Advertisement PDF downloadLoading ...