Photo Credit: Bobboz

The following is a summary of “Variation in content discussed by specialty in consultations for clinically localized prostate cancer,” published in the May 2024 issue of Urology by Friedrich et al.

Effective decision-making in prostate cancer (PC) treatment is bolstered by multidisciplinary consultations, yet the distinct content emphasized by different specialties during these consultations remains poorly understood.

The researchers transcribed 50 treatment consultations involving urologists, radiation oncologists, and medical oncologists in a multidisciplinary setting. Narrative content from these consultations was analyzed using open coding, categorizing topics into major thematic areas. Word count for each content area per consultation served as a proxy for discussion duration. Multivariable Poisson regression assessed the incidence rate ratios (IRR) for specialty-specific word counts, adjusting for patient demographics and tumor risk.

Eight primary content areas emerged: an overview of PC, medical history, baseline risk assessment, cancer prognosis, consideration of competing health risks, treatment options, physician recommendations, and shared decision-making (SDM). Significant variations were observed among specialties discussing treatment options, SDM, competing risks, and cancer prognosis. Urologists dedicated 1.8 times more discussion time to cancer prognosis than medical oncologists (IRR 1.80, 95% CI: 1.14–2.83) and radiation oncologists (IRR 1.84, 95% CI: 1.10–3.07). Urologists (IRR 11.38, 95% CI: 6.62–19.56) and medical oncologists (IRR 10.60, 95% CI: 6.01–18.72) allocated over 10-fold more time to discussing competing risks than radiation oncologists. Medical oncologists (IRR 2.60, 95% CI: 1.65–4.10) and radiation oncologists (IRR 1.77, 95% CI: 1.06–2.95) spent 2.6-fold and 1.8-fold more time on SDM, respectively, compared to urologists.

Specialties involved in PC consultations prioritize distinct aspects of patient care. Findings underscore the need for urologists to enhance discussions on SDM, while radiation oncologists should focus more on addressing competing health risks. Moreover, the pivotal role of medical oncologists in facilitating SDM emerges as crucial in optimizing patient-centered decision-making processes.

Source: sciencedirect.com/science/article/abs/pii/S1078143924004320