Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions

Abstract

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 (PSA < 20; Gleason 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 vs. 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 = .45). Instead, receipt of active treatment was predicted primarily by urologists’ recommendations (Δχ2(2) = 32.81 p < .001). Urologists’ recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but 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 upon 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.

Does maternity care decision‐making conform to shared decision‐ making standards for repeat cesarean and labor induction after suspected macrosomia?

“…Furthermore, information about potential interventions was conveyed disproportionately, with providers being much more likely in both cases to explain the benefits of having, rather than not having, the intervention. This would appear in contrast with the finding by Yoon et al in a national survey of obstetricians in which 93% of respondents indicated that a “physician should provide all relevant facts without influencing the patient's decision 1 way or another.” Providers also generally expressed their own recommendations to have the interventions, which in the case of repeat cesarean, was associated with a much greater likelihood of having the intervention, a finding similar to that of Scherr et al concerning provider‐patient interactions about intervention for treatment of prostate cancer. In Diamond‐Brown's series of interviews with obstetricians concerning shared decision‐making, some reported a sense of conflict between their desire to respect patient choice and reliance on their experience and expertise as to the best course of action .…”

Influence of Men’s Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer

“…A study of 167 LPC patients by Sommers et al concluded that it is likely that the association between physician specialty and LPC treatment choice reflects both patient preferences and physician bias toward the treatment options offered by their specialty [35]. Two more recent studies confirmed that physician recommendation influenced treatment choice [36, 37]. In addition, it was found that men expressing a preference for AS were more likely to have received a physician recommendation for AS and less likely to have received a recommendation for active therapy [37].…”

Papillary thyroid microcarcinoma: decision-making, extent of surgery, and outcomes

“…Studies further indicate that prostate cancer patients are not always presented with all of the treatment options; and the type of treatment recommended depends heavily on the specialty and practice setting of the treating physician (30, 31). One study shows that patients’ treatment choices can actually be predicted by the provider’s recommendation (32). Given these findings, it is not surprising that the recommendations of PTMC providers’ also drive decision-making.…”