Analysis of consultant decision-making in the management of prostate cancer

The purpose of this study was to assess the consistency of decision-making among consultant urologists in the management of early prostate cancer. Thirty-two UK urology consultants completed a questionnaire containing 70 paper scenarios representing patients with early prostate cancer. Within these were 13 repeat cases to allow assessment of reliability of decision-making. Consultants demonstrated low reliability (on average 56-79%) when formulating decisions. None of the consultants used all of the available patient information when formulating treatment plans. The cue 'patient choice' was not used significantly by any of the consultants and the cue 'patient co-morbidity' was rarely used despite being crucial components of decision-making. These results are surprising and in general represent poor clinical practice. They also justify the increasing use of the multidisciplinary team and protocol-driven pathways to standardize and thus improve patient care.