Patient Race and Outcome Preferences as Predictors of Urologists Treatment Recommendations and Referral Patterns in Early-Stage Prostate Cancer
Annual rept. 31 Oct 2005-30 Oct 2006
COLORADO UNIV HEALTH SCIENCES CENTER AURORA CO
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This is a nationally-representative mailed survey of 2000 urologists to 1 collect information about physician sociodemographics and clinical practice characteristics and 2 relate this information to treatment recommendations in three clinical vignettes. The vignettes allow for assessments of the independent effects of patient race, age, socioeconomic status, and tumor characteristics on urologist treatment recommendations in the setting of moderate grade, localized prostate carcinoma. To date, we have completed the survey and written three manuscripts. Two of these have been accepted for publication and a third is under review. A fourth is in preparation. The survey response rate was 66.1, which is excellent. Key findings include the following. First, patient social vulnerability interacts with race to influence urologist treatment recommendations for radical prostatectomy. This is a novel finding with important implications for health disparities research more broadly. Second, the vast majority of urologists report performing fewer than 2.5 radical prostatectomies per month. Based on volume-outcome literature for radical prostatectomy, this raises significant concerns about surgical skill and outcomes. Third, a majority of urologists rate their own surgical outcomes as better than the national average, and a significant proportion provide erroneous information about comparative outcomes for major treatment modalities. Finally, for a hypothetical 77 year old patient who desires cure, 85 of urologists recommended aggressive therapy when the patient has few concerns about treatment side effects and 68 of urologists recommended aggressive therapy when the patient does have concerns about side effects. These results are concerning because aggressive therapy confers little survival benefit but a high likelihood of side effects that should be avoided even in patients who profess little concern about side effects.
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