title: Perceptions of Urologists About the Conversational Elements Leading to Treatment Decision-Making Among Newly Diagnosed Prostate Cancer Patients.
abstract: Widespread adoption and use of the practice of shared decision-making among health-care providers, especially urologists, has been limited. This study explores urologists' perceptions about their conversational practices leading to decision-making by newly diagnosed prostate cancer patients facing treatment. Semi-structured, in-depth interviews were conducted with 12 community and academic urologists practicing in the St. Louis, MO, region. Data were analyzed using a consensus coding approach. Urologists reported spending 30-60 min with newly diagnosed prostate cancer patients when discussing treatment options. They frequently encouraged family members' involvement in discussions about treatment, especially patients' spouses and children. Participants perceived these conversations to be difficult given the emotional burden associated with a cancer diagnosis, and encouraged patients to postpone their decisions or to get a second opinion before finalizing their treatment of choice. Initial discussions included a presentation of treatment options relevant to the patient's condition, side effects, outcome probabilities, and next steps. Urologists seldom used statistics while talking about treatment outcome probabilities and preferred to explain outcomes in terms of the patient's practical, emotional, and social experiences. Their styles to elicit the patient's preferences ranged from explicitly asking questions to making assumptions based on clinical experience and subtle patient cues. In conclusion, urologists' routine conversations included most elements of shared decision-making. However, shared decision-making required urologists to have nuanced discussions and be skilled in elicitation methods and risk discussions which requires further training. Further research is required to explore roles of family and clinical staff as participants in this process.
authors.affiliation: Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA. dr.padsul@gmail.com.|Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA. dr.padsul@gmail.com.
authors.forename: Prajakta
authors.identifier: http://orcid.org/0000-0003-2860-4378
authors.initials: P
authors.lastname: Adsul
authors.affiliation: Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA.|Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Wray
authors.affiliation: Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Boyd
authors.affiliation: Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Weaver
authors.affiliation: Department of Surgery, School of Medicine, Saint Louis University, 3635 Vista Ave, St. Louis, MO, 63110, USA.|Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Siddiqui
mesh_terms: D002755:Choice Behavior; D003142:Communication; D003657:Decision Making; D006801:Humans; D008297:Male; D008923:Missouri; D057240:Patient Preference / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D018454:Spouses / Q000523:psychology; D000072178:Urologists / Q000523:psychology*
keywords: Doctor patient communication; Prostate cancer; Qualitative; Shared decision making