Introduction: Life expectancy (LE) is a critical but often overlooked factor in prostate cancer treatment decision making, as evidenced by high rates of overtreatment among those with limited LE. There is a lack of data regarding patient perspectives on how LE information ought to be communicated in treatment consultations. We sought to develop patient-centered strategies to optimize communication of LE through interviews of men considering treatment.
Methods: We recruited men with low- and intermediate-risk prostate cancer to participate in 30-60-minute semi-structured interviews following treatment consultations. Patient views on importance of LE, whether and how it had been mentioned, barriers to discussing LE, confidence in LE estimate, and ideal mode of communication were ascertained using open-ended questions. We assessed frequency of responses to identify common attitudes.
Results: Of 20 total subjects, the majority (15/20, 75%) recalled that LE had been discussed during treatment consultations. Level of detail of LE estimates ranged from vague generalization (e.g. “long”) (5/15, 33%) to number of years (e.g. “you will live until 90”) (3/15, 20%) to specific probability of survival at a timepoint (“33% probability of living 15 years”) (7/15, 47%). Of those who did not recall hearing about LE, the majority (4/5, 80%) thought it would have been helpful. The predominant barrier to hearing LE was anxiety (12/20, 60%), which subjects noted could be reduced by providing a range of years or depersonalizing the information (e.g. “LE for patients like you”). The vast majority (15/19, 77%) had low to moderate confidence in LE estimates in general and noted that explaining how LE was calculated (9/20, 45%) or including their health conditions into the calculation (5/20, 25%) would make them more confident. When offered a hypothetical scenario to determine the ideal mode of communication of LE, the majority preferred a specific number of years (12/19, 63%) over probability of survival at a timepoint (4/19, 21%) or vague generalization (3/19, 16%). The vast majority of subjects (18/20, 80%) felt that LE information should always be provided in treatment consultations.
Conclusions: Men with prostate cancer in our study strongly endorsed inclusion of detailed LE information in treatment consultations. They generally desired to be given LE in a number of years format to optimize understanding. To maximize confidence in LE estimates, explaining the calculation method and incorporating patient-specific medical conditions was preferred. Source of
