Patient Participation in Consultations for Clinically Localized Prostate Cancer

Shared decision-making (SDM) for prostate cancer (PCa) treatment requires active participation of patients and providers. While the physician's role has been studied extensively, the patient's role in SDM is poorly characterized. We sought to describe variation in patient participation and thematic content during consultations for localized PCa.

Six thousand six hundred one patient statements from 50 multispecialty consultations across 10 providers were analyzed for content and speech type using an open coding approach and then categorized into major themes. The proportion of patient words, statement types, and counts of statements described content. We used a generalized linear mixed model to identify predictors of words spoken, questions asked, and words related to SDM including sociodemographic data, decisional conflict score, and autonomy preference index scores.

Patient speech comprised a median of 19.9% (IQR: 12.7%, 32.3%) of total words per consultation, with a broad range (1.8%-51.1%). Coders identified 5 primary types of speech segments: Acknowledgments (27.7% of patient quotes), Expressions/Preferences (8.8%), Questions/Requests (21.5%), Providing information (34.5%), and other (7.6%). There was a median of 18.5 (IQR: 9, 32) patient questions per consultation, with a broad range (3-128). The median proportion of patient speech related to SDM (ie, treatment preferences, treatment values, or decision-making process) was 3.4% (IQR: 1.85%-6.74%). In multivariable models, only tumor risk was associated with engagement in SDM (incidence rate ratio: 2.43, 95% CI: 1.17-5.01 for favorable and incidence rate ratio: 2.23, 95% CI: 1.11-4.47 for unfavorable/high), while otherwise there were no significant predictors of the number of patient words, questions asked, or statements related to SDM.

Patient participation in PCa consultations was highly variable, with no consistent predictors. Minimal time is spent expressing preferences, values, or the decision-making process. Providers should adjust practices to ensure adequate participation, specifically prioritizing elicitation of values and preferences.