Topic Mapping to Inform Content to Discuss in Shared Decision-Making for Prostate Cancer

To develop a framework for shared decision-making (SDM) in prostate cancer (PC) by identifying key topics that are covered during consultations. Although SDM is the guidelines-endorsed standard of care, there is no widely accepted standard for what to discuss during SDM. Previous data suggests content discussed during SDM is highly variable.

We transcribed consultations of 50 men with localized PC across multidisciplinary providers. Analysts extracted quotes related to SDM, thematically coded transcripts using an open coding approach, and aggregated consensus themes into broader categories. Frequency of thematic content at a consultation level was calculated.

Of 50 consultations, 39 (78%) had at least one quote related to SDM. Three major thematic content areas were identified: description of the decision-making process (35/39, 90%), patient preferences and values (31/39, 79%), and physician preferences (30/39, 77%). Description of the decision-making process, not included in current American Urological Association SDM guidelines, included five sub-content areas: (1) general description of SDM, (2) patient role, (3) physician role, (4) decisions order, and (5) decision-making hazards to avoid. These sub-content areas were further subdivided into detailed areas of content discussed. For example, general description of SDM included describing how to make a decision (69%), endorsing the shared nature of decision making (43%), and the difficulty of treatment decisions (23%).

Our topic-mapped framework outlines the major thematic content areas covered in PC SDM, which providers can use to guide SDM discussions with patients. Description of the decision-making process-which is critical to ensuring patients understand their active role in SDM-should be included in future iterations of American Urological Association SDM guidelines.