title: Clinical implementation of quality of life instruments and prediction tools for localized prostate cancer: results from a national survey of radiation oncologists and urologists.
abstract: OBJECTIVE
  Although clinical guidelines recommend assessing quality of life, cancer aggressiveness and life expectancy for making localized prostate cancer treatment decisions, it is unknown whether instruments that objectively measure such outcomes have disseminated into clinical practice. In this context we determined whether quality of life and prediction instruments for prostate cancer have been adopted by radiation oncologists and urologists in the United States.
  
  
  METHODS
  Using a nationally representative mail survey of 1,422 prostate cancer specialists in the United States, we queried about self-reported clinical implementation of quality of life instruments, prostate cancer nomograms and life expectancy prediction tools in late 2011. The Pearson chi-square test and multivariate logistic regression were used to determine differences in the use of each instrument by physician characteristics.
  
  
  RESULTS
  A total of 313 radiation oncologists and 328 urologists completed the survey for a 45% response rate. Although 55% of respondents reported using prostate cancer nomograms, only 27% and 23% reported using quality of life and life expectancy prediction instruments, respectively. On multivariate analysis urologists were less likely to use quality of life instruments than radiation oncologists (OR 0.40, p <0.001). Physicians who spent 30 minutes or more counseling patients were consistently more likely to use quality of life instruments (OR 2.57, p <0.001), prostate cancer nomograms (OR 1.83, p = 0.009) and life expectancy prediction tools (OR 1.85, p = 0.02) than those who spent less than 15 minutes.
  
  
  CONCLUSIONS
  Although prostate cancer nomograms have been implemented into clinical practice to some degree, the use of quality of life and life expectancy tools has been more limited. Increased attention to implementing validated instruments into clinical practice may facilitate shared decision making for patients with prostate cancer.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Jeanette Y
authors.initials: JY
authors.lastname: Ziegenfuss
authors.forename: Leona C
authors.initials: LC
authors.lastname: Han
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Beebe
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011237:Predictive Value of Tests; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D018787:Radiation Oncology / Q000592:standards* / Q000639:trends; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D014481:United States; D014572:Urology / Q000592:standards* / Q000639:trends