AUA2023 BEST POSTERS Variation in Content Discussed by Specialty in Consultations for Clinically Localized Prostate Cancer

By: Nadine A. Friedrich, MD, Cedars-Sinai Medical Center, Los Angeles, California; Michael Luu, MPH, Cedars-Sinai Medical Center, Los Angeles, California; Rebecca Gale, MPH, Cedars-Sinai Medical Center, Los Angeles, California; Antwon Chaplin, MPH, Cedars-Sinai Medical Center, Los Angeles, California; Reva Polineni, BS, Pennsylvania State University, University Park; Alex Shiang, BS, Washington University in St Louis, Missouri; Dong Shin, BS, David Geffen School of Medicine, University of California Los Angeles; Stephen J. Freedland, MD, Cedars-Sinai Medical Center, Los Angeles, California; Veterans Affairs Health Care System, Durham, North Carolina; Brennan Spiegel, MD, Cedars-Sinai Medical Center, Los Angeles, California; Paul Kokorowski, MD, MPH, Cedars-Sinai Medical Center, Los Angeles, California; Timothy J. Daskivich, MD, MSHPM, Cedars-Sinai Medical Center, Los Angeles, California | Posted on: 30 Aug 2023

Figure. Incidence rate ratio for time spent on major content area by provider specialty.

Multidisciplinary treatment consultations—having the patient meet with urology, radiation oncology, and medical oncology to discuss management options—have been shown to improve informed decision-making and reduce uncertainty surrounding treatment choice for men with prostate cancer.1,2 By involving a diverse group of specialists, patients should theoretically gain a more nuanced understanding of the available treatment options and their associated risks and benefits, and have a greater opportunity to engage in shared decision-making.3,4 However, it is unknown what unique information each specialty discusses with patients during consultations that confers these benefits.

In this study, we investigated how content discussed in multidisciplinary consults for prostate cancer varies by provider specialty. We digitally recorded and transcribed consultations of 50 men with clinically localized prostate cancer and qualitatively analyzed consultations for narrative content using an open coding approach. Coders empirically identified 8 major content areas: (1) shared decision-making (SDM), (2) physician recommendations, (3) discussion of treatments, (4) life expectancy/competing risks, (5) cancer prognosis, (6) assessment of baseline risk, (7) medical/family history, and (8) overview of prostate cancer. We calculated the number of words devoted to each content area per consult as a proxy for time spent and compared the incidence rate ratio for content-specific word counts across specialties using a multivariable Poisson regression.

The entire corpus of text included 220,993 words and 7,042 sentences, comprised of 123,848 (56%) words from urologists, 56,726 (26%) from radiation oncologists, and 40,419 (18%) from medical oncologists. Specialties primarily differed in time spent on 3 content areas (aside from discussions of specialty-specific treatments): SDM, life expectancy/competing risks, and cancer prognosis. Medical oncologists spent 2.6-fold more time (95% CI: 2.4-6.0) and radiation oncologists spent 1.7-fold more time (95% CI: 0.9-2.5) discussing SDM than urologists (see Figure). Differences were primarily driven by incorporating patient values and preferences and reviewing other doctors’ recommendations. Urologists spent 11.3-fold more time (95% CI: 6.6-19.6) and medical oncologists spent 10.6-fold more time (95% CI: 6.0-18.7) discussing life expectancy/competing risks than radiation oncologists (see Figure). Urologists spent 1.8-fold more time discussing cancer prognosis than both radiation oncologists (95% CI: 1.1-2.8) and medical oncologists (95% CI: 1.1-3.1; see Figure).

These findings show that different specialties emphasize different content areas during treatment consultations for prostate cancer. This variation in content discussed may contribute to better patient education and engagement in SDM and lead to the benefits in decision-making observed with multidisciplinary consultations. Additionally, our findings underscore the need for urologists to be more engaged in SDM with their patients in order to match the appropriate treatment option to the patient’s individual values and preferences.5

  1. Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol. 2018;199(3):683-690.
  2. Sheridan SL, Golin C, Bunton A, et al. Shared decision making for prostate cancer screening: the results of a combined analysis of two practice-based randomized controlled trials. BMC Med Inform Decision Mak. 2012;12(1):130.
  3. Kurpad R, Kim W, Rathmell WK, et al. A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions?. Urol Oncol. 2011; 29(4):378-382.
  4. Korman H, Lanni TJ, Shah C, et al. Impact of a prostate multidisciplinary clinic program on patient treatment decisions and on adherence to NCCN guidelines: the William Beaumont Hospital experience. Am J Clin Oncol. 2013;36(2):121-125.
  5. Makarov DV, Chrouser K, Gore JL, et al. AUA white paper on implementation of shared decision making into urological practice. Urol Pract. 2016;3(5):355-363.