When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment

Abstract

Background The role of primary care providers (PCP) in decision-making around cancer care remains largely unknown. We evaluated how frequently men with localized prostate cancer report receiving help from their PCP about their treatment, and whether those men who do, are less likely to receive definitive treatment. Methods We mailed surveys to men newly diagnosed with localized prostate cancer between 2012 and 2014 in the greater Philadelphia region. Participants were asked whether their PCP helped decide how to treat their cancer. The outcome was receipt of definitive treatment (either radical prostatectomy or radiotherapy). Results 2386 men responded (adjusted response rate 51.1%). 38.2% of men reported receiving help from their PCP about treatment, and 79.6%received definitive treatment. In adjusted analyses, non-Hispanic black men (OR 1.73; 95% CI 1.33-2.24) were more likely than non-Hispanic white men to report receiving help from their PCP. However, men who did receive help were not more likely to forgo definitive treatment overall (p=0.58) or in the subgroups of men who may be least likely to benefit from definitive treatment. Conclusions Though a substantial proportion of men reported receiving help from their PCP about prostate cancer treatment, these discussions were not associated with different treatment patterns. Further effort is needed to determine how to optimize primary care physicians' role in supporting patients to make preference-sensitive cancer decisions.

Primary care provider–reported involvement in breast cancer treatment decisions

“…Our prior work with the iCanCare study patient participants found that more than one‐third of women reported that their PCP was involved in their breast cancer treatment decisions, and this participation was greatest among minority women, those with less education, and those with more comorbidities . In addition, prior research suggests that more than one‐third of men with prostate cancer report that their PCP helped them with their treatment decision . Our findings expand upon this prior work by investigating PCPs’ reports of involvement in different cancer treatment decisions.…”

“…Our results suggest that up to a third of PCPs participate in breast cancer surgery decisions, but they participate less often in radiation and chemotherapy decisions. Prior literature suggests that PCPs may be increasingly called upon to engage in cancer treatment decision making . Our prior work with the iCanCare study patient participants found that more than one‐third of women reported that their PCP was involved in their breast cancer treatment decisions, and this participation was greatest among minority women, those with less education, and those with more comorbidities .…”

“…Patients may also increasingly consult their primary care providers (PCPs) about treatment decisions, particularly as the cancer population ages and collaborative care models are adopted in practice. Prior studies suggest that PCP involvement in collaborative cancer care often begins as early as diagnosis, and they support the idea that many PCPs remain engaged during the acute treatment phase . In addition, population‐based surveys of patients with early‐stage cancer suggest that patients perceive their PCPs to be participating in their treatment decisions, with approximately one‐third of patients with breast cancer reporting that their PCP participated in their treatment decisions .…”

“…Prior studies suggest that PCP involvement in collaborative cancer care often begins as early as diagnosis, and they support the idea that many PCPs remain engaged during the acute treatment phase. 12,13 In addition, population-based surveys of patients with early-stage cancer suggest that patients perceive their PCPs to be participating in their treatment decisions, with approximately one-third of patients with breast cancer reporting that their PCP participated in their treatment decisions. 12 Yet, we know little about the extent to which PCPs perceive that they are participating in multimodal treatment decisions, and how they appraise their ability to effectively participate in shared decision making in this context remains unclear.…”

Research on Clinical Decisions Made Daily in Family Medicine

“…Two studies show that significant gaps exist in patients' knowledge about localized prostate cancer treatment and outcomes, and that many men discuss the possibilities with their primary care providers. 3,4 Do patients with more knowledge have an easier time making decisions regarding treatment for their prostate cancer? Do men who talk with their primary care provider make different treatment choices?…”