Patient participation lacking in prostate cancer consultations

A recent study has noted high variability in patient participation in consultations for clinically localized prostate cancer, with no consistent predictors. Moreover, time spent in expressing preferences, values, or the decision-making process is minimal.

The investigators analysed a total of 6,601 patient statements from 50 multispecialty consultations across 10 providers for content and speech type using an open coding approach and categorized these into major themes. They then identified predictors of words spoken, questions asked, and words related to shared decision-making (SDM) using a generalized linear mixed model.

Patient speech accounted for a median of 19.9 percent of total words per consultation, with a broad range (1.8 percent to 51.5 percent). Five primary types of speech segments were identified, namely acknowledgments (27.7 percent of patient quotes), expressions/preferences (8.8 percent), questions/requests (21.5 percent), providing information (34.5 percent), and other (7.6 percent).

The median number of patient questions was 18.5 per consultation, with a broad range (3‒128), while the median proportion of patient speech related to SDM (ie, treatment preferences, treatment values, or decision-making process) was 3.4 percent.

Multivariate analysis revealed tumour risk as the only factor associated with engagement in SDM (favourable: incidence rate ratio [IRR], 2.43, 95 percent confidence interval [CI], 1.17‒5.01; unfavourable/high: IRR, 2.23, 95 percent CI, 1.11‒4.47). Notably, no significant predictors were found for the number of patient words, questions asked, or statements related to SDM.

“Providers should adjust practices to ensure adequate participation, specifically prioritizing elicitation of values and preferences,” the investigators said.