Physician Preferences Regarding Integration of Life Expectancy in Prostate Cancer Management

Area of Science:

• Oncology
• Geriatric Medicine
• Medical Ethics

Background:

• Current guidelines recommend life expectancy (LE) cutoffs for localized prostate cancer management.
• Physicians often do not communicate patient-specific LE estimates, potentially leading to overtreatment of men with limited longevity.

Purpose of the Study:

• To identify physician barriers to integrating LE into prostate cancer management.
• To assess physician confidence in LE estimates and preferred communication methods.

Main Methods:

• Structured interviews with 20 multidisciplinary oncologists treating prostate cancer patients.
• Verbatim transcription and open coding of interviews, with saliency analysis for concept description.

Main Results:

• Key barriers include patient receptiveness (75%), LE prediction tool accuracy (50%), and communication knowledge (30%).
• Most physicians (85%) used non-quantitative LE assessment methods (gestalt or life tables).
• Physician confidence in LE predictions was low (35%) or moderate (60%), citing estimate variability and need for model validation.

Conclusions:

• Addressing physician concerns regarding patient receptiveness, communication skills, and prediction confidence is crucial.
• Improving LE integration may reduce overtreatment in men with limited life expectancy.