Prostate cancer and prostatic diseases · 2026
Variation in quality of physician communication in prostate cancer consultations.
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Friedrich Nadine A, Luu Michael, Zheng Renning, Hernandez-Tirado Alexander, Freedland Stephen J, Spiegel Brennan, Kokorowski Paul, Daskivich Timothy J
Аннотация
BACKGROUND: Clear communication of treatment risks and benefits is essential for shared decision making (SDM) in prostate cancer (PC). However, the quality of physician communication in real-world consultations remains poorly characterized. We assessed variation in quality of risk communication in PC consultations and its association with patient, tumor, and provider characteristics.
MATERIALS AND METHODS: We conducted a prospective cohort study of 50 PC consultations in a multispecialty cohort of physicians (3 urologists, 3 medical oncologists, 3 radiation oncologists), with an analytic sample comprising 19,388 sentences. Transcripts were coded for five AUA-endorsed SDM content areas: cancer severity, life expectancy (LE), oncologic endpoints, baseline function, and treatment side effects (SEs). Analysts extracted all statements on these topics and scored communication quality using a validated 6-point scale (0 = omission, 1 = name only, 2 = binary assessment of risk, 3 = imprecise quantification, 4 = specific quantification, and 5 = patient-specific estimate). For each consultation, we calculated overall (weighted average) and content-specific scores. We then conducted an exploratory analysis of variation in communication quality by patient, tumor, and provider characteristics.
RESULTS: Communication quality varied substantially across consultations and content areas. Cancer severity had the highest median score (5, IQR 4-5), indicating this information was typically communicated using patient-specific estimates. LE had a median of 3 (IQR 2-5), indicating imprecise quantification. Oncologic endpoints also had a median of 3 (IQR 2-3). Baseline function and SEs had the lowest median of 1 (IQRs 1-2 and 0-2), indicating name-only communication. Exploratory analyses revealed that overall communication quality was lower for Black patients, higher among urologists, increased with higher tumor risk, and varied by physician. Content-specific quality did not improve in subgroups where the content was clinically relevant (e.g., LE quality was not higher for patients with limited LE).
CONCLUSIONS: Quality of physician communication in PC consultations varies across content areas and may be influenced by patient, tumor, and provider characteristics.
MATERIALS AND METHODS: We conducted a prospective cohort study of 50 PC consultations in a multispecialty cohort of physicians (3 urologists, 3 medical oncologists, 3 radiation oncologists), with an analytic sample comprising 19,388 sentences. Transcripts were coded for five AUA-endorsed SDM content areas: cancer severity, life expectancy (LE), oncologic endpoints, baseline function, and treatment side effects (SEs). Analysts extracted all statements on these topics and scored communication quality using a validated 6-point scale (0 = omission, 1 = name only, 2 = binary assessment of risk, 3 = imprecise quantification, 4 = specific quantification, and 5 = patient-specific estimate). For each consultation, we calculated overall (weighted average) and content-specific scores. We then conducted an exploratory analysis of variation in communication quality by patient, tumor, and provider characteristics.
RESULTS: Communication quality varied substantially across consultations and content areas. Cancer severity had the highest median score (5, IQR 4-5), indicating this information was typically communicated using patient-specific estimates. LE had a median of 3 (IQR 2-5), indicating imprecise quantification. Oncologic endpoints also had a median of 3 (IQR 2-3). Baseline function and SEs had the lowest median of 1 (IQRs 1-2 and 0-2), indicating name-only communication. Exploratory analyses revealed that overall communication quality was lower for Black patients, higher among urologists, increased with higher tumor risk, and varied by physician. Content-specific quality did not improve in subgroups where the content was clinically relevant (e.g., LE quality was not higher for patients with limited LE).
CONCLUSIONS: Quality of physician communication in PC consultations varies across content areas and may be influenced by patient, tumor, and provider characteristics.