Men with prostate cancer prefer patient-specific, quantitative assessments of longevity in shared decision making. We sought to characterize how physicians communicate the three components of competing risks-life expectancy (LE), cancer prognosis, and treatment-related survival benefit-in treatment consultations.
Conversation related to LE, cancer prognosis, and treatment-related survival benefit was identified in transcripts from treatment consultations of 42 men with low- and intermediate-risk disease across 10 multidisciplinary providers. Consensus of qualitative coding by multiple reviewers noted the most detailed mode of communication used to describe each throughout the consultation.
Physicians frequently failed to provide patient-specific, quantitative estimates of LE and cancer mortality. LE was omitted in 17% of consultations, expressed as a generalization (eg, "long"/"short") in 17%, rough number of years in 31%, probability of mortality/survival at an arbitrary timepoint in 17%, and in only 19% as a specific number of years. Cancer mortality was omitted in 24% of consultations, expressed as a generalization in 7%, years of expected life in 2%, probability at no/arbitrary timepoint in 40%, and in only 26% as the probability at LE. Treatment-related survival benefit was often omitted; cancer mortality was reported without treatment in 38%, with treatment in 10%, and in only 29% both with and without treatment. Physicians achieved "trifecta"-(1)quantifying probability of cancer mortality (2)with and without treatment (3)at the patient's LE-in only 14% of consultations.
Physicians often fail to adequately quantify competing risks. We recommend the "trifecta" approach, reporting (1)probability of cancer mortality (2)with and without treatment (3)at the patient's LE.
The Journal of urology. 2022 Apr 04 [Epub ahead of print]
Timothy J Daskivich, Rebecca Gale, Michael Luu, Aurash Naser-Tavakolian, Abhi Venkataramana, Dmitry Khodyakov, Jennifer T Anger, Edwin Posadas, Howard Sandler, Brennan Spiegel, Stephen J Freedland
Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California., Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, California., Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California., Department of Urology, University of Southern California, Los Angeles, California., RAND Institute, Santa Monica, California., Department of Urology, University of California, San Diego, San Diego, California., Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California., Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.