PD25-06 VARIATION IN COMMUNICATION OF COMPETING RISKS OF MORTALITY IN PROSTATE CANCER TREATMENT CONSULTATIONS

Abstract

You have accessJournal of UrologyCME1 May 2022PD25-06 VARIATION IN COMMUNICATION OF COMPETING RISKS OF MORTALITY IN PROSTATE CANCER TREATMENT CONSULTATIONS Aurash Naser-Tavakolian, Rebecca Gale, Michael Luu, Abhishek Venkataramana, Dmitry Khodyakov, Jennifer Anger, Edwin Posadas, Howard Sandler, Brennan Spiegel, Stephen Freedland, and Timothy Daskivich Aurash Naser-TavakolianAurash Naser-Tavakolian More articles by this author , Rebecca GaleRebecca Gale More articles by this author , Michael LuuMichael Luu More articles by this author , Abhishek VenkataramanaAbhishek Venkataramana More articles by this author , Dmitry KhodyakovDmitry Khodyakov More articles by this author , Jennifer AngerJennifer Anger More articles by this author , Edwin PosadasEdwin Posadas More articles by this author , Howard SandlerHoward Sandler More articles by this author , Brennan SpiegelBrennan Spiegel More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , and Timothy DaskivichTimothy Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with prostate cancer prefer patient-specific, quantitative assessments of longevity in shared decision making. We sought to qualitatively characterize how physicians communicate the three components of competing risks—life expectancy, cancer prognosis, and treatment-related survival benefit—in treatment consultations. METHODS: Conversation related to life expectancy, cancer prognosis, and treatment-related survival benefit was identified in transcripts from treatment consultations of 42 men with low- and intermediate-risk disease across 10 providers (4 urologists, 2 radiation oncologists, and 4 medical oncologists). Consensus of multiple reviewers noted the most detailed mode of communication used to describe each component of competing risks throughout the consultation. RESULTS: Physicians frequently failed to provide patient-specific, quantitative estimates of both life expectancy and cancer mortality. Life expectancy was omitted in 17% of consultations, expressed as a generalization (e.g. “long”/”short”) in 17%, rough number of years in 31%, probability of mortality/survival at an arbitrary timepoint in 17%, and in only 19% as a specific number of years. Cancer mortality was omitted in 24% of consultations, expressed as a generalization in 7%, years of expected life in 2%, probability at an arbitrary timepoint in 40%, and in only 21% as the probability at the patient’s life expectancy. Treatment-related survival benefit was often omitted; cancer mortality was reported without treatment in 38%, with treatment in 10%, and in only 29% both with and without treatment. Illustrative quotes for these modes of communication are provided in Table 1. Physicians achieved “trifecta”—(1) quantifying probability of cancer mortality (2) with and without treatment (3) at the patient’s life expectancy—in only 14% of consultations. CONCLUSIONS: Physicians often fail to adequately quantify competing risks. We recommend the “trifecta” approach for communicating competing risks, reporting (1) probability of cancer mortality (2) with and without treatment (3) at the patient’s life expectancy. Source of Funding: This work was supported by Career Development Award (K08 CA230155 to TJD) from the National Cancer Institute © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e423 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aurash Naser-Tavakolian More articles by this author Rebecca Gale More articles by this author Michael Luu More articles by this author Abhishek Venkataramana More articles by this author Dmitry Khodyakov More articles by this author Jennifer Anger More articles by this author Edwin Posadas More articles by this author Howard Sandler More articles by this author Brennan Spiegel More articles by this author Stephen Freedland More articles by this author Timothy Daskivich More articles by this author Expand All Advertisement PDF DownloadLoading ...