Daskivich Timothy J, Naser-Tavakolian Aurash, Gale Rebecca, Luu Michael, Friedrich Nadine, Venkataramana Abhi, Khodyakov Dmitry, Posadas Edwin, Sandler Howard, Spiegel Brennan, Freedland Stephen J
Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Prostate Cancer Prostatic Dis. 2025 Mar;28(1):145-152. doi: 10.1038/s41391-024-00806-2. Epub 2024 Feb 23.
Effective communication of treatment side effects (SE) is critical for shared decision-making (SDM) in localized prostate cancer. We sought to qualitatively characterize how physicians communicate SE in consultations.
We transcribed 50 initial prostate cancer treatment consultations across nine multidisciplinary providers (Urologists, Radiation Oncologists, Medical Oncologists) at our tertiary referral, academic center. Coders identified quotes describing SE and used an inductive approach to establish a hierarchy for granularity of communication: (1) not mentioned, (2) name only, (3) generalization("high"), (4) average incidence without timepoint, (5) average incidence with timepoint, and (6) precision estimate. We reported the most granular mode of communication for each SE throughout the consultation overall and across specialty and tumor risk.
Among consultations discussing surgery (n = 40), erectile dysfunction (ED) and urinary incontinence (UI) were omitted in 15% and 12%, not quantified (name only or generalization) in 47% and 30%, and noted as average incidence without timeline in 8% and 8%, respectively. In only 30% and 49% were ED and UI quantified with timeline (average incidence with timeline or precision estimate), respectively. Among consultations discussing radiation (n = 36), irritative urinary symptoms, ED, and other post-radiotherapy SE were omitted in 22%, 42%, and 64-67%, not quantified in 61%, 33%, and 23-28%, and noted as average incidence without timeline in 8%, 22%, and 6-8%, respectively. In only 3-8% were post-radiotherapy SE quantified with timeline. Specialty concordance (but not tumor risk) was associated with higher granularity of communication, though physicians frequently failed to quantify specialty-concordant SE.
SE was often omitted, not quantified, and/or lacked a timeline in treatment consultations in our sample. Physicians should articulate, quantify, and assign a timeline for SE to optimize SDM.
治疗副作用（SE）的有效沟通对于局限性前列腺癌的共同决策（SDM）至关重要。我们试图定性描述医生在会诊中如何沟通副作用。
我们转录了在我们的三级转诊学术中心，由九位多学科医疗人员（泌尿科医生、放射肿瘤学家、医学肿瘤学家）进行的50次前列腺癌初始治疗会诊。编码人员识别出描述副作用的引述内容，并采用归纳法建立沟通详细程度的层次结构：（1）未提及，（2）仅提及名称，（3）概括性描述（“高”），（4）无时间点的平均发生率，（5）有时间点的平均发生率，以及（6）精确估计。我们报告了在整个会诊过程中，以及跨专业和肿瘤风险情况下，每种副作用最详细的沟通方式。
在讨论手术的会诊中（n = 40），勃起功能障碍（ED）和尿失禁（UI）分别有15%和12%被遗漏，47%和30%未进行量化（仅提及名称或概括性描述），8%和8%被记录为无时间线的平均发生率。ED和UI分别只有30%和49%被量化了时间线（有时间线的平均发生率或精确估计）。在讨论放疗的会诊中（n = 36），刺激性泌尿系统症状、ED和其他放疗后副作用分别有22%、42%和64 - 67%被遗漏，61%、33%和23 - 28%未进行量化，8%、22%和6 - 8%被记录为无时间线的平均发生率。放疗后副作用只有3 - 8%被量化了时间线。专业一致性（而非肿瘤风险）与更高的沟通详细程度相关，不过医生们常常未能对专业一致的副作用进行量化。
在我们的样本中，治疗会诊中副作用常常被遗漏、未被量化，和/或缺乏时间线。医生应该明确阐述、量化副作用，并为其设定时间线，以优化共同决策。
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