Variation in communication of cancer risk in prostate cancer treatment consultations.

Abstract

e23126 Background: Effective communication of cancer risk is essential for shared decision-making in prostate cancer treatment. We aimed to qualitatively characterize how physicians communicate cancer severity and common oncologic endpoints in consultations. Methods: We transcribed 50 initial prostate cancer treatment consultations across 10 multidisciplinary providers at a tertiary referral academic center. Analysts identified quotes describing cancer severity (tumor risk and pathology results) and oncologic endpoints (risk of progression, metastasis, and mortality), and then used an inductive approach to qualitatively characterize modes of communication for each topic. Analysts then rank ordered these modes of communication into a hierarchy describing increasing level of detail for each. We reported the most granular mode of communication for each topic throughout the consultation. Results: Communication of tumor risk and pathology results ranged from (1) not mentioned, (2) name only, (3) generalization, (4) patient-specific result (risk group for tumor risk and Gleason score for pathology results) without and (5) with qualification, to (6) patient-specific result with qualification and additional information (explanation of guidelines-concordant treatments and core sampling, respectively). Tumor risk and pathology results were often mentioned (92% and 96% of consultations, respectively) and explained with both qualification and additional information (66% and 60% of consultations, respectively). Communication of oncologic endpoints ranged from (1) not mentioned, (2) name only, (3) generalization, to (4) probability with no timeline, (5) at arbitrary timepoint, and (6) at patient’s life expectancy. Oncologic endpoints were often omitted, with 34%, 22%, 34% of consultations not mentioning the risks of progression, metastasis, and mortality respectively. Quantification of progression and metastasis as a probability was rare, in only 14% and 32% of consultations, respectively, while mortality risk was more often quantified, with 58% consultations providing a probability. Conclusions: While tumor risk and pathology results were often communicated with substantial detail, the risks of progression, metastasis, and mortality were often omitted or left unquantified. Hierarchy Tumor Risk Pathology Results Progression Risk Metastasis Risk Mortality Risk Not Mentioned 4 (8%) 2 (4%) 17 (34%) 11 (22%) 17 (34%) Name Only 1 (2%) 0 (0%) 15 (30%) 9 (18%) 0 (0%) Generalization 0 (0%) 4 (8%) 11 (22%) 14 (28%) 4 (8%) Patient-Specific Results without Qualification / Probability without Timeline 6 (12%) 3 (6%) 0 (0%) 11 (22%) 4 (8%) Patient-Specific Results with Qualification / Probability at Arbitrary Timepoint 6 (12%) 11 (22%) 6 (12%) 2 (4%) 18 (36%) Patient-Specific Results with Qualification and Additional Information / Probability at Patient's Life Expectancy 33 (66%) 30 (60%) 1 (2%) 3 (6%) 7 (14%)