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How Men with Prostate Cancer Choose Specialists: A Qualitative Study
Tammy Jiang1, Christian H Stillson1, Craig Evan Pollack1
1From the Brown University School of Public Health, Providence, RI (TJ); the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (CHS, LC, DG); the Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD (CEP, AR); the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (MR); and the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (DG).
Objective:
The specific specialist that a patient sees can have a large influence on the type of care they receive.
Methods:
We administered semistructured interviews with 47 men diagnosed with prostate adenocarcinoma between 2012 and 2014. Telephone interviews were recorded, transcribed, and analyzed using a systematic thematic approach.
Results:
Three profiles of patients emerged for choosing specialists: active (21.3%), partially active (53.2%), and passive (25.5%). Active patients conducted substantial research when choosing a diagnosing urologist and a treating specialist: they searched online, consulted other men with prostate cancer, and/or visited multiple specialists for opinions. Partially active patients took only 1 additional step to find a treating specialist on their own after receiving a referral from their diagnosing urologist. Passive patients relied exclusively on referrals from their primary care physicians (PCPs) and diagnosing urologists.
Conclusion:
The majority of patients relied on their PCPs for referrals to diagnosing urologists and on their diagnosing urologists to choose the treating specialist. Given these findings and the significance of specialist choice in determining treatment, it is important that PCPs recognize their indirect but potentially important effect on treatment choice when making referrals for prostate cancer. PCPs should consider counseling patients about seeking second opinions from providers with different treatment perspectives and participating in treatment decisions.