Provider and partner interactions in the treatment decision-making process for newly diagnosed localized prostate cancer

Authors


Scott D. Ramsey, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA 98109-1024, USA. e-mail: sramsey@fhcrc.org

Abstract

Study Type – Patient experience (non-consecutive cohort)

Level of Evidence 3b

What’s known on the subject? and What does the study add?

Decisions about prostate cancer treatment usually involve the patient, the patient’s closest family member (e.g. spouse or partner) and the physician, however no study has examined this “triad” of decision makers in detail. Moreover, no study has evaluated the role that prostate cancer patients’ partners play in the treatment decision-making process.

This study provides evidence that partners are very involved in the treatment decision making between loved ones and providers and often attend clinic visits. Provider encouragement of partner participation was associated with higher partner satisfaction and an increased likelihood of partners reporting very frequent discussions with their loved ones.

OBJECTIVE

• To evaluate the degree to which the partners of prostate cancer patients participate in the shared decision-making process with the patients’ providers during the time between diagnosis and initiating treatment.

PATIENTS AND METHODS

• We recruited patients with newly diagnosed local-stage prostate cancer and their partners to complete take-home surveys after biopsy but before initiating treatment at urology practices in three states.

• We asked partners to describe their roles in the decision-making process, including participation in clinic visits, and perceptions of encouragement from providers to participate in the treatment decision-making process. We also asked partners to rate their satisfaction with the patients’ providers.

RESULTS

• Family members of 80% of newly diagnosed patients agreed to participate; most (93%) were partners (i.e. spouses or significant others). Most partners (93%) had direct contact with the patients’ physicians.

• Among the partners who had contact with providers, most (67%) were very satisfied with the patients’ providers and 80% indicated that the doctor encouraged them to participate in the treatment decision. Overall, 91% of partners reported very frequent discussions with their loved one about the pending treatment decision, and 69% reported that their role was to help the patient make a decision.

• In multivariate models, provider encouragement of partner participation was associated with higher partner satisfaction (odds ratio 3.4, 95% CI 1.4–8.4) and an increased likelihood of partners reporting very frequent discussions with their loved one (odds ratio 6.1, 95% CI 1.3–27.7).

CONCLUSIONS

• Partners often attended clinic visits and were very involved in discussions about treatment options with both loved ones and providers.

• Provider encouragement of participation by partners greatly facilitates shared decision-making between patients and partners.

Ancillary