Informed Decision Making: Assessment of the Quality of Physician Communication about Prostate Cancer Diagnosis and Treatment.

Published

Journal Article

Little is known about how physicians present diagnosis and treatment planning in routine practice in preference-sensitive treatment decisions. We evaluated completeness and quality of informed decision making in localized prostate cancer post biopsy encounters.We analyzed audio-recorded office visits of 252 men with presumed localized prostate cancer (Gleason 6 and Gleason 7 scores) who were seeing 45 physicians at 4 Veterans Affairs Medical Centers. Data were collected between September 2008 and May 2012 in a trial of 2 decision aids (DAs). Braddock's previously validated Informed Decision Making (IDM) system was used to measure quality. Latent variable models for ordinal data examined the relationship of IDM score to treatment received.Mean IDM score showed modest quality (7.61±2.45 out of 18) and high variability. Treatment choice and risks and benefits were discussed in approximately 95% of encounters. However, in more than one-third of encounters, physicians provided a partial set of treatment options and omitted surveillance as a choice. Informing quality was greater in patients treated with surveillance (β = 1.1, p = .04). Gleason score (7 vs 6) and lower age were often cited as reasons to exclude surveillance. Patient preferences were elicited in the majority of cases, but not used to guide treatment planning. Encounter time was modestly correlated with IDM score (r = 0.237, p = .01). DA type was not associated with IDM score.Physicians informed patients of options and risks and benefits, but infrequently engaged patients in core shared decision-making processes. Despite patients having received DAs, physicians rarely provided an opportunity for preference-driven decision making. More attention to the underused patient decision-making and engagement elements could result in improved shared decision making.

Full Text

Duke Authors

Cited Authors

  • Holmes-Rovner, M; Montgomery, JS; Rovner, DR; Scherer, LD; Whitfield, J; Kahn, VC; Merkle, EC; Ubel, PA; Fagerlin, A

Published Date

  • November 2015

Published In

Volume / Issue

  • 35 / 8

Start / End Page

  • 999 - 1009

PubMed ID

  • 26304063

Pubmed Central ID

  • 26304063

Electronic International Standard Serial Number (EISSN)

  • 1552-681X

International Standard Serial Number (ISSN)

  • 0272-989X

Digital Object Identifier (DOI)

  • 10.1177/0272989x15597226

Language

  • eng