Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, California.
J Urol. 2022 Aug;208(2):301-308. doi: 10.1097/JU.0000000000002675. Epub 2022 Apr 4.
Men with prostate cancer prefer patient-specific, quantitative assessments of longevity in shared decision making. We sought to characterize how physicians communicate the 3 components of competing risks-life expectancy (LE), cancer prognosis and treatment-related survival benefit-in treatment consultations.
Conversation related to LE, 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 multidisciplinary providers. Consensus of qualitative coding by multiple reviewers noted the most detailed mode of communication used to describe each throughout the consultation.
Physicians frequently failed to provide patient-specific, quantitative estimates of LE and cancer mortality. LE was omitted in 17% of consultations, expressed as a generalization (eg "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 no/arbitrary timepoint in 40% and in only 26% as the probability at LE. 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. Physicians achieved "trifecta"-1) quantifying probability of cancer mortality 2) with and without treatment 3) at the patient's LE-in only 14% of consultations.
Physicians often fail to adequately quantify competing risks. We recommend the "trifecta" approach, reporting 1) probability of cancer mortality 2) with and without treatment 3) at the patient's LE.
患有前列腺癌的男性在共同决策中更喜欢针对个体的、定量的长寿评估。我们试图描述医生在治疗咨询中如何沟通竞争风险的三个组成部分-预期寿命（LE）、癌症预后和治疗相关的生存获益。
在 10 名多学科提供者的 42 名低风险和中风险疾病男性的治疗咨询记录中，识别与 LE、癌症预后和治疗相关的生存获益相关的对话。多位评论员对定性编码达成共识，指出在整个咨询过程中最详细地描述每个组成部分的沟通模式。
医生经常未能提供针对个体的、定量的 LE 和癌症死亡率估计。在 17%的咨询中省略了 LE，17%的咨询中以概括的方式表示（例如“长”/“短”），31%的咨询中以大致的年数表示，17%的咨询中以任意时间点的死亡率/生存率的概率表示，只有 19%的咨询中以具体的年数年数表示。在 24%的咨询中省略了癌症死亡率，7%的咨询中以概括的方式表示，2%的咨询中以预期寿命的年数表示，40%的咨询中以任意时间点的概率表示，只有 26%的咨询中以 LE 时的概率表示。治疗相关的生存获益经常被省略；在 38%的咨询中没有治疗时报告癌症死亡率，在 10%的咨询中报告有治疗时报告癌症死亡率，只有 29%的咨询中同时报告了有治疗和没有治疗时的癌症死亡率。医生仅在 14%的咨询中达到了“三重奏”-1）量化癌症死亡率的概率 2）有和没有治疗 3）在患者的 LE 时。
医生经常未能充分量化竞争风险。我们建议采用“三重奏”方法，报告 1）癌症死亡率的概率 2）有和没有治疗 3）在患者的 LE 时。
