MP31-14: Variation in Communication of Side Effects in Prostate Cancer Treatment Consultations

Saturday, May 14, 2022 2:45 PM to 4:00 PM
Room 228
Health Services Research


Authors: Aurash Naser-Tavakolian*, Rebecca Gale, Michael Luu, Abhishek Venkataramana, Los Angeles, CA, Dmitry Khodyakov, Santa Monica, CA, Edwin Posadas, Howard Sandler, Jennifer Anger, Brennan Spiegel, Stephen Freedland, Timothy Daskivich, Los Angeles, CA

Introduction: Effective communication of treatment side effects is a key component of prostate cancer shared decision making. We qualitatively characterized how physicians communicate risk of side effects in treatment consultations.

Methods: We prospectively transcribed treatment consultations of 42 men with non-metastatic prostate cancer across 10 providers (4 urologists, 2 radiation oncologists, and 4 medical oncologists). Coders identified quotes related to side effects. Mode of risk communication was graded on a scale of increasing granularity: (1) name only (without risk quantification), (2) generalization (“high”), (3) average percent incidence at timepoint, and (4) precision estimate/nomogram. The most granular mode of risk communication used to describe each side effect throughout the consultation was reported.

Results: Among consultations discussing surgery, side effects mentioned included erectile dysfunction (ED) (29/34, 85%), incontinence (29/34, 85%), and operative risks (11/34, 32%). When mentioned, postoperative ED, incontinence, and operative risks were not quantified (mentioned by name only or generalization) in 18/29 (62%), 20/29 (69%), and 7/11(64%) of consultations, respectively. Illustrative quotes of varying risk communication are provided in Table 1. Among consultations discussing radiation, side effects mentioned included post-radiation ED (15/28, 54%), irritative urinary symptoms (LUTS) (21/28, 75%), secondary malignancy (10/28, 36%), bowel/bladder bleeding (11/28, 39%), and bowel dysfunction (7/28, 25%). When mentioned, post-radiation ED and irritative LUTS were not quantified in 14/15 (93%) and 17/21 (81%) of consultations, respectively. Risks of secondary malignancy, bowel/bladder bleeding, and bowel dysfunction were similarly often not quantified (all > 79%, Figure 1).

Conclusions: Side effects of prostate cancer treatment are often omitted or not quantified in treatment consultations. Physicians should articulate and quantify risks to optimize informed shared decision making.

Source of Funding: This work was supported by Career Development Award (K08 CA230155 to TJD) from the National Cancer Institute.