Skip to main content

Advertisement

SpringerLink
Log in

Perceptions of Urologists About the Conversational Elements Leading to Treatment Decision-Making Among Newly Diagnosed Prostate Cancer Patients

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Widespread adoption and use of the practice of shared decision-making among health-care providers, especially urologists, has been limited. This study explores urologists’ perceptions about their conversational practices leading to decision-making by newly diagnosed prostate cancer patients facing treatment. Semi-structured, in-depth interviews were conducted with 12 community and academic urologists practicing in the St. Louis, MO, region. Data were analyzed using a consensus coding approach. Urologists reported spending 30–60 min with newly diagnosed prostate cancer patients when discussing treatment options. They frequently encouraged family members’ involvement in discussions about treatment, especially patients’ spouses and children. Participants perceived these conversations to be difficult given the emotional burden associated with a cancer diagnosis, and encouraged patients to postpone their decisions or to get a second opinion before finalizing their treatment of choice. Initial discussions included a presentation of treatment options relevant to the patient’s condition, side effects, outcome probabilities, and next steps. Urologists seldom used statistics while talking about treatment outcome probabilities and preferred to explain outcomes in terms of the patient’s practical, emotional, and social experiences. Their styles to elicit the patient’s preferences ranged from explicitly asking questions to making assumptions based on clinical experience and subtle patient cues. In conclusion, urologists’ routine conversations included most elements of shared decision-making. However, shared decision-making required urologists to have nuanced discussions and be skilled in elicitation methods and risk discussions which requires further training. Further research is required to explore roles of family and clinical staff as participants in this process.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Cancer Society (ACS) (2015) What are the key statistics about prostate cancer? http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics. Accessed 2015

  2. Boehmer U, Clark JA (2001) Married couples' perspectives on prostate cancer diagnosis and treatment decision-making. Psychooncology 10(2):147–155. doi:10.1002/pon.504

    Article  CAS  PubMed  Google Scholar 

  3. Caldon LJ, Collins KA, Reed MW, Sivell S, Austoker J, Clements AM, Patnick J, Elwyn G, Group BresDex (2011) Clinicians’ concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. Health Expect 14(2):133–146. doi:10.1111/j.1369-7625.2010.00633.x

    Article  PubMed  Google Scholar 

  4. Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D’Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J (2007) Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol 177(2):540–545

    Article  CAS  PubMed  Google Scholar 

  5. Davison BJ, Gleave ME, Goldenberg SL, Degner LF, Hoffart D, Berkowitz J (2002) Assessing information and decision preferences of men with prostate cancer and their partners. Cancer Nurs 25(1):42–49

    Article  PubMed  Google Scholar 

  6. Edwards A, Elwyn G, Mulley A (2002) Explaining risks: turning numerical data into meaningful pictures. BMJ 324(7341):827–830

    Article  PubMed  PubMed Central  Google Scholar 

  7. Elwyn G, Edwards A, Gwyn R, Grol R (1999) Towards a feasible model for shared decision making: focus group study with general practice registrars. BMJ 319(7212):753–756

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E et al (2012) Shared decision making: a model for clinical practice. J Gen Intern Med 27(10):1361–1367. doi:10.1007/s11606-012-2077-6

    Article  PubMed  PubMed Central  Google Scholar 

  9. Elwyn G, Hutchings H, Edwards A, Rapport F, Wensing M, Cheung WY, Grol R (2005) The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks. Health Expect 8(1):34–42. doi:10.1111/j.1369-7625.2004.00311.x

    Article  PubMed  PubMed Central  Google Scholar 

  10. Eysenbach G, Muir Gray JA, Bonati M, Arunachalam S, Diepgen TL, Impicciatore P, Pandolfini C (1998) Towards quality management of medical information on the internet: evaluation, labelling, and filtering of information. BMJ 317(7171):1496–1502. doi:10.1136/bmj.317.7171.1496

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Gravel K, Legare F, Graham ID (2006) Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implement Sci 1:16. doi:10.1186/1748-5908-1-16

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hayes J, Barry MJ (2011) Preventing prostate cancer overdiagnosis from becoming overtreatment. Oncology (Williston Park) 25(6):468–471, 478

    Google Scholar 

  13. Hoffman RM (2012) Improving the communication of benefits and harms of treatment strategies: decision AIDS for localized prostate cancer treatment decisions. J Natl Cancer Inst Monogr 2012(45):197–201. doi:10.1093/jncimonographs/lgs023

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kassirer JP (1995) The next transformation in the delivery of health care. N Engl J Med 332(1):52–54. doi:10.1056/NEJM199501053320110

    Article  CAS  PubMed  Google Scholar 

  15. Lieber E, Weisner TS (2013) Dedoose. In: Web-based qualitative and mixed-methods computer software

    Google Scholar 

  16. Lin GA, Aaronson DS, Knight SJ, Carroll PR, Dudley RA (2009) Patient decision aids for prostate cancer treatment: a systematic review of the literature. CA Cancer J Clin 59(6):379–390. doi:10.3322/caac.20039

    Article  PubMed  Google Scholar 

  17. Makoul G, Clayman ML (2006) An integrative model of shared decision making in medical encounters. Patient Educ Couns 60(3):301–312. doi:10.1016/j.pec.2005.06.010

    Article  PubMed  Google Scholar 

  18. McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 22(3):276–282

    Article  Google Scholar 

  19. Miles MB, Michael Huberman A, Saldaña J (2013) Qualitative data analysis: a methods sourcebook. SAGE Publications Incorporated, Thousand Oaks

    Google Scholar 

  20. Moyer VA, U. S. Preventive Services Task Force (2012) Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 157(2):120–134. doi:10.7326/0003-4819-157-2-201207170-00459

    Article  PubMed  Google Scholar 

  21. National Comprehensive Cancer Network (2004) Prostate cancer. NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2(3):224

    Article  Google Scholar 

  22. O'Connor AM, Légaré F, Stacey D (2003) Risk communication in practice: the contribution of decision aids. BMJ 327(7417):736–740

    Article  PubMed  PubMed Central  Google Scholar 

  23. Politi MC, Studts JL, Hayslip JW (2012) Shared decision making in oncology practice: what do oncologists need to know? Oncologist 17(1):91–100. doi:10.1634/theoncologist.2011-0261

    Article  PubMed  PubMed Central  Google Scholar 

  24. Robinson TN, Patrick K, Eng TR, Gustafson D, Communication for the Science Panel on Interactive, and Health (1998) An evidence-based approach to interactive health communication: a challenge to medicine in the information age. JAMA 280(14):1264–1269. doi:10.1001/jama.280.14.1264

    Article  CAS  PubMed  Google Scholar 

  25. Say RE, Thomson R (2003) The importance of patient preferences in treatment decisions—challenges for doctors. BMJ 327(7414):542–545. doi:10.1136/bmj.327.7414.542

    Article  PubMed  PubMed Central  Google Scholar 

  26. Shukla-Dave A, Hricak H, Akin O, Yu C, Zakian KL, Udo K, Scardino PT, Eastham J, Kattan MW (2012) Preoperative nomograms incorporating magnetic resonance imaging and spectroscopy for prediction of insignificant prostate cancer. BJU Int 109(9):1315–1322

    Article  PubMed  Google Scholar 

  27. Stapleton H, Kirkham M, Thomas G (2002) Qualitative study of evidence based leaflets in maternity care. BMJ 324(7338):639. doi:10.1136/bmj.324.7338.639

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wyatt K, Branda M, Anderson R, Pencille L, Montori V, Hess E, Ting H, LeBlanc A (2014) Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters. Implement Sci 9(1):26

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We acknowledge the urologists and thank them for the time they took out of their busy schedules to participate in this study.

Author information

Authors and Affiliations

  1. Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA

    Prajakta Adsul, Ricardo Wray, Danielle Boyd & Nancy Weaver

  2. Department of Surgery, School of Medicine, Saint Louis University, 3635 Vista Ave, St. Louis, MO, 63110, USA

    Sameer Siddiqui

  3. Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA

    Prajakta Adsul, Ricardo Wray & Sameer Siddiqui

Authors
  1. Prajakta Adsul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ricardo Wray
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Danielle Boyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nancy Weaver
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sameer Siddiqui
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prajakta Adsul.

Ethics declarations

The Saint Louis University Institutional Review Board approved the study.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Role of Funding and Conflict of Interest

Funding for this work was made possible with the support of the Saint Louis University Center for Cancer Prevention, Research and Outreach with funds from Emerson, Express Scripts Foundation, and Ascension Health. The funding sources had no involvement in the study design; collection, analysis, and interpretation of data; writing of the report; and decision to submit the paper for publication.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1

Interview Guide. (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adsul, P., Wray, R., Boyd, D. et al. Perceptions of Urologists About the Conversational Elements Leading to Treatment Decision-Making Among Newly Diagnosed Prostate Cancer Patients. J Canc Educ 32, 580–588 (2017). https://doi.org/10.1007/s13187-016-1025-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-016-1025-2

Keywords

Search

Navigation