Quality of care received and patient-reported regret in prostate cancer: Analysis of a population-based prospective cohort.
BACKGROUND
Meeting quality of care standards in oncology is recognized as important by physicians, professional organizations, and payers. Data from a population-based cohort of patients with prostate cancer were used to examine whether receipt of care was consistent with published consensus metrics and whether receiving high-quality care was associated with less patient-reported treatment decisional regret.


METHODS
Patients with incident prostate cancer were enrolled in collaboration with the North Carolina Central Cancer Registry, with an oversampling of minority patients. Medical record abstraction was used to determine whether participants received high-quality care based on 5 standards: 1) discussion of all treatment options; 2) complete workup (prostate-specific antigen, Gleason grade, and clinical stage); 3) low-risk participants did not undergo a bone scan; 4) high-risk participants treated with radiotherapy (RT) received androgen deprivation therapy; and 5) participants treated with RT received conformal or intensity-modulated RT. Treatment decisional regret was assessed using a validated instrument.


RESULTS
A total of 804 participants were analyzed. Overall, 66% of African American and 73% of white participants received care that met all standards (P = .03); this racial difference was confirmed by multivariable analysis. Care that included "discussion of all treatment options" was found to be associated with less patient-reported regret on univariable analysis (P = .03) and multivariable analysis (odds ratio, 0.59; 95% confidence interval, 0.37-0.95).


CONCLUSIONS
The majority of participants received high-quality care, but racial disparity existed. Participants who discussed all treatment options appeared to have less treatment decisional regret. To the authors' knowledge, this is the first study to demonstrate an association between a quality of care metric and patient-reported outcome. Cancer 2017;138-143. © 2016 American Cancer Society.
Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jordan A
http://orcid.org/0000-0002-2178-6079
JA
Holmes
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.
Jeannette T
JT
Bensen
University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.|Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
James L
JL
Mohler
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Lixin
L
Song
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Merle H
MH
Mishel
Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.|Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Ronald C
RC
Chen
D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D003657:Decision Making / Q000502:physiology; D004644:Emotions / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods; D009657:North Carolina; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology
D017430:Prostate-Specific Antigen
patient-reported outcomes; prostate cancer; quality of care; racial disparities; regret