Physician Preferences Regarding Integration of Life Expectancy in Prostate Cancer Management

Guidelines endorse specific life expectancy (LE) cutoffs for consideration of definitive management of localized prostate cancer. Previous work has shown that patients prefer numeric, patient-specific LE estimates in consultations but that physicians often do not communicate LE in such detail. The persistent overtreatment of men with limited longevity despite these guidelines may in part be related to physician-mediated factors.

To determine physician barriers to the integration of LE in prostate cancer management, confidence in LE estimates, preferred method for LE calculation, and mode of LE communication in consultations.

Structured interview study.

Multidisciplinary cohort of 20 urologists, radiation oncologists, and medical oncologists who regularly counsel patients with prostate cancer.

Interviews were transcribed verbatim and coded using an open coding approach. Saliency analysis was used to describe emergent concepts.

Physician-identified barriers to integration of LE in consultations included concerns about patient receptiveness (75%), the accuracy of LE prediction tools (50%), and lack of knowledge about how to effectively communicate LE (30%). There was significant heterogeneity in the sources of information used to calculate LE, with 85% using methods not incorporating a quantitative assessment of health status (55% gestalt method, 30% life tables). Most physicians had low (35%) or moderate (60%) confidence in LE predictions, which they cite as due to high variability in estimates (65%) and the need for further validation of predictive models (20%). To improve confidence in estimates, physicians wished for validated prediction tools (45%), incorporation of more variables (45%), reporting of the variability of LE estimates (30%), and molecular/genetic biomarkers (25%).

Addressing physician concerns about patient receptiveness, lack of knowledge about effective LE communication, and lack of confidence in LE predictions may be essential to reducing overtreatment of men with limited LE.