To examine the treatment recommendation patterns among urologists and radiation oncologists, the level of concordance or discordance between physician recommendations, and the association between physician recommendations and the treatment that patients received.
The study was a secondary analysis of data from a randomized clinical trial conducted November 2010 to April 2014 (NCT02053389). Eligible participants were patients from the trial who saw both specialists. The primary outcome was physician recommendations that were scored using an adapted version of the validated PhyReCS coding system. Secondary outcomes included concordance between physician recommendations and the treatment patients received.
Participants were 108 patients (Mean age 61.9 years; range 43-82; 87% non-Hispanic White). Urologists were more likely to recommend surgery (79% of recommendations) and radiation oncologists were more likely to recommend radiation (68% of recommendations). Recommendations from the urologists and radiation oncologists were concordant for only 33 patients (30.6%). Most patients received a treatment that both physicians recommended (59%); however, 35% received a treatment that only one of their physicians recommended. When discordant, urologists more often recommended surgery and radiation oncologists recommended radiation and surgery as equally appropriate options.
Urologists and radiation oncologists are more likely to differ than agree in their treatment recommendations for the same patients with clinically localized prostate cancer and more likely to favor treatment aligned with their specialty. Additional studies are needed to better understand how patients make decisions after meeting with two different specialists to inform the development of best practices within oncology clinics.
Urology. 2022 Jun 26 [Epub ahead of print]
Rebecca K Delaney, Brittany L Sisco-Taylor, Xuechen Wang, Karen Scherr, Peter A Ubel, Benjamin Haaland, Valerie C Kahn, Daniel Hamstra, John T Wei, Farrah Madanay, J Kelly Davis, Taylor U Greeno, Angela Fagerlin
University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, United States., Department of Family Medicine and Community Health, Duke University, United States., Sanford School of Public Policy, Duke University, United States., Center for Bioethics and Social Sciences in Medicine, University of Michigan, United States., Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, United States., Department of Urology, University of Michigan, United States., Fuqua School of Business, Duke University, United States., Trinity College of Arts and Sciences, Duke University., University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah, United States; Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance, United States. Electronic address: .