Patient-centered care is associated with the influence of physicians' prostate cancer treatment recommendations

Background: Patient-centered care, which emphasizes sharing healthcare decision-making with patients and treating patients respectfully and empathetically, is increasingly being adopted as a principle of healthcare quality. We tested the role of patient-centeredness in a healthcare decision with significant quality of life and economic consequences: the choice to treat prostate cancer with active surveillance rather than definitive therapy (surgery or radiation). Method: Prostate cancer patients (N=126) being followed with active surveillance at a comprehensive cancer center completed a self-report assessment of their treatment decision-making process. We tested the hypothesis that patients would report being more influenced by their physician treatment recommendations to the degree that they hold more positive perceptions of their relationship with their physicians, independent of the treatment that was recommended, using general estimating equations (GEE). As prostate cancer patients often consult more than one physician prior to making their treatment decision, we asked men to report on their relationships with up to four physicians (2 urologists and 2 radiation oncologists), depending on how many were consulted. Results: Patients had been followed with active surveillance for a mean of 3.0 years (SD=2.0; range = 0.3-13.5). At diagnosis, participant mean age was 64.4 years (SD=6.8); median PSA range was 5-9; and median Gleason score was 6. Trust in the physician, the degree to which the physician shared control over treatment decision-making, and perceived closeness with the physician were associated with being more influenced by the physician's recommendation, even after controlling for the type of treatment recommended (ps<.008). Having been treated badly by a physician was associated with being less likely to be influenced by the physician's treatment recommendation in bivariate analyses, but not after controlling for type of treatment recommended. Having received a recommendation for active surveillance, but not surgery or radiation, was also associated with being more influenced by the recommendation in all models (ps<.001). Discussion: There is increasing concern that patients with relatively less aggressive prostate cancer or older age are being unnecessarily treated with surgery or radiation, putting them at high risk for negative side-effects and increasing healthcare costs. When active surveillance is an appropriate course of treatment, patients' relationships with their physicians may be an important determinant of following a recommendation for active surveillance. More generally, results indicate that the quality of the physician-patient relationship, including trust, closeness, and sharing of decision-making -all elements of patient-centered care- may be important motivators of treatment adoption and adherence.