Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions.
نویسندگان
چکیده
OBJECTIVE To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer. METHODS We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients' baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients' interest in sex. RESULTS Patients' initial treatment preferences did not predict receipt of active treatment versus surveillance, Δχ2(4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists' recommendations, Δχ2(2) = 32.81, P < 0.001. Urologists' recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, Δχ2(6) = 0, P = 1. Urologists rarely discussed patients' interest in sex (<15% of appointments). CONCLUSIONS Patients' treatment decisions were based largely on urologists' recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients' personal views of the relative pros and cons of treatment alternatives.
منابع مشابه
Factors that influence patient preferences for prostate cancer management options: A systematic review
PURPOSE We performed a systematic review to evaluate evidence regarding factors that influence patient preferences for management options for localized prostate cancer. METHODS We followed a prespecified search protocol (PROSPERO identifier CRD42014009173) to identify studies that evaluated patient preferences for prostate cancer management options for localized prostate cancer. We queried Pu...
متن کاملHelping patients with localized prostate cancer reach treatment decisions.
OBJECTIVE To highlight the role of psychosocial variables in treatment decision making for patients with localized prostate cancer and how family physicians can be of most help to such patients in facilitating good treatment choices. QUALITY OF EVIDENCE PubMed was searched, and articles relevant to the psychosocial aspects of localized prostate cancer treatment decision making were included. ...
متن کاملUsing a web - based decision support intervention to facilitate patient - physician communication at prostate cancer treatment discussions
Purpose: To measure the preferences and values of men newly diagnosed with prostate cancer (PC) using a web-based decision support technology—the Decision Support Intervention-Prostate Cancer (DSI-PC). Methods: Health information seeking behaviour, factors having an influence on the treatment decision, decision control, and preferred treatment were recorded by the DSI-PC program prior to the tr...
متن کاملSexual side effects and prostate cancer treatment decisions: patient information needs and preferences.
Prostate cancer treatment decision making requires complex trade-offs among treatment outcomes, and sexual function is a central consideration for most men. Although sexual function is included in prostate cancer decision models, survival and fear of recurrence and cancer progression weigh more heavily in these decisions for many men than concerns about treatment impact on sexuality. In this ar...
متن کاملConsidering racial and ethnic preferences in communication and interactions among the patient, family member, and physician following diagnosis of localized prostate cancer: study of a US population
Prostate cancer is the most commonly diagnosed cancer among American men. The multiple treatment options for localized prostate cancer and potential side effects can complicate the decision-making process. We describe the level of engagement and communication among the patient, family member, and physician (the decision-making "triad") in the decision process prior to treatment. Using the Famil...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Medical decision making : an international journal of the Society for Medical Decision Making
دوره 37 1 شماره
صفحات -
تاریخ انتشار 2017