Variation in content discussed by specialty in consultations for clinically localized prostate cancer

Nadine A Friedrich; Michael Luu; Rebecca Gale; Antwon Chaplin; Leslie Ballas; Howard M Sandler; Edwin M Posadas; Stephen J Freedland; Brennan Spiegel; Paul Kokorowski; Timothy J Daskivich

doi:10.1016/j.urolonc.2024.04.012

Variation in content discussed by specialty in consultations for clinically localized prostate cancer

Urol Oncol. 2024 May 17:S1078-1439(24)00432-0. doi: 10.1016/j.urolonc.2024.04.012. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
² Biostatistics and Bioinformatics Core, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³ Cedars-Sinai Center for Outcomes. Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁴ Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Department of Medicine, Division of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles , CA, USA.
⁶ Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Surgery, Urology Section, Veterans Affairs Health Care System, Durham, NC, USA; Center for Integrated Research in Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁷ Cedars-Sinai Center for Outcomes. Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Pediatrics,Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸ Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Pediatrics,Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁹ Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes. Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: timothy.daskivich@cshs.org.

PMID: 38762384
DOI: 10.1016/j.urolonc.2024.04.012

Abstract

Introduction: Multidisciplinary consultations improve decisional conflict and guideline-concordant treatment for men with prostate cancer (PC), but differences in the content discussed by specialty during consultations are unknown.

Methods: We audiorecorded and transcribed 50 treatment consultations for localized PC across a multidisciplinary sample of urologists, radiation oncologists, and medical oncologists. Conversation was coded for narrative content using an open coding approach, grouping similar topics into major content areas. The number of words devoted to each content area per consult was used as a proxy for time spent. Multivariable Poisson regression calculated incidence rate ratios (IRR) for content-specific word count across specialties after adjustment for tumor risk and patient demographics.

Results: Coders identified 8 narrative content areas: overview of PC; medical history; baseline risk; cancer prognosis; competing risks; treatment options; physician recommendations; and shared decision making (SDM). In multivariable models, specialties significantly differed in proportion of time spent on treatment options, SDM, competing risks, and cancer prognosis. Urologists spent 1.8-fold more time discussing cancer prognosis than medical oncologists (IRR1.80, 95%CI:1.14-2.83) and radiation oncologists (IRR1.84, 95%CI:1.10-3.07). Urologists (IRR11.38, 95%CI:6.62-19.56) and medical oncologists (IRR10.60, 95%CI:6.01-18.72) spent over 10-fold more time discussing competing risks than radiation oncologists. Medical oncologists (IRR2.60, 95%CI:1.65-4.10) and radiation oncologists (IRR1.77, 95%CI:1.06-2.95) spent 2.6- and 1.8-fold more time on SDM than urologists, respectively.

Conclusions: Specialists focus on different content in PC consultations. Our results suggest that urologists should spend more time on SDM and radiation oncologists on competing risks. Our results also highlight the importance of medical oncologists in facilitating SDM.

Keywords: Medical oncology; Prostate cancer; Radiation oncology; Treatment; Urology.