AUA 2012 - The absence of goal setting in the dialogue between metastatic prostate cancer (mCRPC) patients and their physicians: An opportunity for shared decision making? - Session Highlights

ATLANTA, GA USA (UroToday) - Throughout medical practice, we observe that there is often a misalignment between patient expectations of treatment and those of the clinicians managing patients. The communications of treatment objectives in metastatic disease is an expression of the art of medicine. The challenges are even more significant when discussing the quality of life and the quantity of life. In advanced prostate cancer, competing therapies often offer prolongation of life or improvement in quality of life but not both. In this study, the investigators endeavored to understand how metastatic castrate-resistant prostate cancer (mCRPC) patients and their physicians discuss treatment goals.

In this study, the authors received institutional review-board approval, Health Insurance Portability and Accountability Act (HIPAA)-compliant, observational, linguistic study analyzed conversations between mCRPC patients and their oncologists or urologists during a naturally-occurring clinic visit in 2011. The videotaped clinic visits had no 3rd-party observers present and both participants were interviewed separately after the visit using standardized questionnaires. All conversations were analyzed with standard anthropology and discourse analysis techniques.

The authors observed a number of information gaps during 42 clinic visits involving mCRPC patients (69% African-American) and their physicians (7 urologists; 7 oncologists). In particular, explicit conversation about the patients’ goals for therapy or the terminal nature of the disease did not occur in any physician-patient discussion. In post-visit interviews, physicians primarily viewed the care plan as preserving quality of life while patients tended to believe their care plan focused on extending life. Both patients and physicians assumed that their views on treatment goals were aligned with each other. The absence of direct discussion of the treatment goals between the physicians and patients fostered this misalignment between the healthcare providers and the patients.

There are books galore discussing communications issues throughout history. Ofter it is assumed that the misunderstanding or lack of alignment is due to the patient not hearing the physician in these challenging discussions. The findings from this study challenge this assumption, and at least in this research, the discussions were notably absent in the patient-provider conversations. It serves to shine the light on the need to focus on the conversations between patients and providers so that goal and expectations of therapy are understood by mCRPC patients at the end of the discussion.


Presented by Brad Davidson, Matthew DiChiara, Robert A Bailey, Lorie A Ellis, Mekre Senbetta, Andrew J Stephenson and Tracey L Krupski at the American Urological Association (AUA) Annual Meeting - May 19 - 23, 2012 - Georgia World Congress Center - Atlanta, GA USA

View full AUA Coverage