Kaye Deborah R, Tu Karissa, Davis J Kelly, Campagna Ada, Docherty Sharron L, Kurnot Jeremy, Zhang Tian, George Daniel J, Ubel Peter A
Department of Urology, Duke University, Durham, NC, USA.
Duke-Margolis Center for Public Policy, Duke University, Durham, NC, USA.
JU Open Plus. 2024 Mar;2(3). doi: 10.1097/ju9.0000000000000118. Epub 2024 Feb 29.
Promising new treatments exist for advanced prostate cancer. Decision-making is complicated: there is minimal comparative effectiveness data; differing routes of administration, drug mechanisms-of-action and side effects; and significant price differences. These challenges contribute to variations in care and quality, treatment disparities, and lack of concordance with patient values. The aim of this study was to examine physician perspectives of factors influencing decision-making for first-line advanced prostate cancer treatments.
We conducted a qualitative descriptive study of physicians who treat patients with advanced prostate cancer from 09/2021-06/2022. Participants were purposively sampled from across the United States.
Twenty-seven physicians participated. We identified seventeen domains and three overarching themes affecting physician decision-making for advanced prostate cancer care. The themes were: 1) physician and practice factors impact prescribing decisions, 2) health practice resource availability affects the likelihood patients will receive the recommended treatment, and that the treatment will be in-line with patients' values and 3) patient non-clinical factors influence physician decision-making, but patient values could be better incorporated into prescribing decisions. Based upon the analyses, we constructed a preliminary framework of clinician decision-making for advanced prostate cancer.
Physicians perceive non-clinical patient, physician, and practice factors impact decision-making. These factors, therefore, must be considered when implementing programs to optimize a physician's ability to provide quality cancer care, reduce health care disparities and patient financial burden and provide patient goal-concordant care. The preliminary theoretical model of clinician decision-making for advanced prostate cancer care may also be used to inform these efforts.
针对晚期前列腺癌已有前景良好的新治疗方法。决策过程复杂：比较有效性数据极少；给药途径、药物作用机制和副作用各不相同；价格差异显著。这些挑战导致了治疗差异和质量差异、治疗差距以及与患者价值观的不一致。本研究的目的是探讨医生对影响一线晚期前列腺癌治疗决策因素的看法。
我们对2021年9月至2022年6月期间治疗晚期前列腺癌患者的医生进行了一项定性描述性研究。参与者是从美国各地有目的地抽取的。
27名医生参与了研究。我们确定了影响晚期前列腺癌治疗医生决策的17个领域和三个总体主题。这些主题是：1）医生和医疗机构因素影响处方决策；2）医疗实践资源的可获得性影响患者接受推荐治疗的可能性，以及治疗是否符合患者价值观；3）患者的非临床因素影响医生决策，但患者价值观可更好地纳入处方决策。基于分析结果，我们构建了晚期前列腺癌临床医生决策的初步框架。
医生认为患者、医生和医疗机构的非临床因素会影响决策。因此，在实施旨在优化医生提供优质癌症护理的能力、减少医疗差距和患者经济负担以及提供符合患者目标的护理的项目时，必须考虑这些因素。晚期前列腺癌临床医生决策的初步理论模型也可用于指导这些工作。
