title: Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions.
abstract: To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer.
  
  
  
  We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients' baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients' interest in sex.
  
  
  
  Patients' initial treatment preferences did not predict receipt of active treatment versus surveillance, Δχ2(4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists' recommendations, Δχ2(2) = 32.81, P < 0.001. Urologists' recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, Δχ2(6) = 0, P = 1. Urologists rarely discussed patients' interest in sex (<15% of appointments).
  
  
  
  Patients' treatment decisions were based largely on urologists' recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients' personal views of the relative pros and cons of treatment alternatives.
authors: Fuqua School of Business and School of Medicine, Duke University, Durham, NC, USA (KAS).
authors: Karen A
authors: KA
authors: Scherr
authors: Departments of Internal Medicine and Psychology, Center for Bioethics and Sciences in Medicine, University of Michigan Ann Arbor, The Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA (AF).
authors: Angela
authors: A
authors: Fagerlin
authors: Division of Internal Medicine, University of Michigan Ann Arbor, The Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA (TH).
authors: Timothy
authors: T
authors: Hofer
authors: Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS).
authors: Laura D
authors: LD
authors: Scherer
authors: Department of Medicine and Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA (MH-R).
authors: Margaret
authors: M
authors: Holmes-Rovner
authors: Fuqua School of Business, Duke University, Durham, NC, USA (LDW).
authors: Lillie D
authors: LD
authors: Williamson
authors: Division of General Medicine, Department of Internal Medicine, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA (VCK).
authors: Valerie C
authors: VC
authors: Kahn
authors: Department of Urology, University of Michigan Ann Arbor, Department of Surgery, Ann Arbor VA, Ann Arbor, MI, USA (JSM).
authors: Jeffrey S
authors: JS
authors: Montgomery
authors: Department of Urology, University of California San Francisco, Department of Urology, San Francisco VA, San Francisco, CA, USA (KLG).
authors: Kirsten L
authors: KL
authors: Greene
authors: Duke University, Durham, NC, USA (BZ).
authors: Biqi
authors: B
authors: Zhang
authors: Fuqua School of Business, School of Medicine and Sanford School of Public Policy, Duke University, Durham, NC, USA (PAU).
authors: Peter A
authors: PA
authors: Ubel
mesh_terms: D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000523:psychology; D003075:Coitus / Q000523:psychology; D003142:Communication; D003657:Decision Making; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010358:Patient Participation / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000628:therapy*
keywords: Hierarchical Models; Logistic Regression Models; Physician-Patient Communication; Prostate cancer; Qualitative Methods; Shared Decision Making; Urology