Comparative effectiveness of a patient-centered prostate biopsy report in clinical prostate cancer practice.

145 Background: The prostate biopsy pathology report is a critical decision-making document for men newly-diagnosed with prostate cancer, yet the content may be beyond the health literacy of most patients. We compare the effectiveness of a patient-centered prostate biopsy report developed through patient-centered outcomes research methods with standard synoptic reports. Methods: Using a modified Delphi approach, a multidisciplinary group of prostate cancer experts provided consensus for the critical components of a prostate biopsy report for treatment decision-making. Patient focus groups provided input for syntax and formatting to inform the design of a patient-centered pathology report. 94 patients with recent prostate biopsies were block randomized to receive the standard report with or without the patient-centered report. We evaluated patient self-efficacy, provider communication and empathy, and prostate cancer knowledge at pathology disclosure. We compared study groups with descriptive statistics. Results: Experts selected primary and secondary Gleason score and number of positive cores as the important elements of a prostate biopsy report. Patients prioritized a narrative word structure, clear language, a tabular format for histologic grade, and information on risk classification. Initial assessments were completed by 84% (79/94) of participants including 40/46 in the standard report group and 39/48 in the patient-centered report group. Patients who received the patient-centered report had significantly improved ability to recall their Gleason score (100% vs. 85%, p = 0.03) and number of positive cores (90% vs. 65%, p = 0.01). Provider communication and patient self-efficacy were uniformly high and did not differ between groups. 88% of patients who received the patient-centered report felt that it helped them better understand their pathology results. Conclusions: A patient-centered prostate biopsy pathology report is associated with significantly higher knowledge about a new prostate cancer diagnosis. These health information documents may help facilitate shared decision-making among patients newly diagnosed with prostate cancer.

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Ethnographic investigation of patient–provider communication among African American men newly diagnosed with prostate cancer: a study protocol

BMJ Open ◽

10.1136/bmjopen-2019-035032 ◽

2020 ◽

Vol 10 (8) ◽

pp. e035032

Author(s):

Nynikka R Palmer ◽

Janet K Shim ◽

Celia P Kaplan ◽

Dean Schillinger ◽

Sarah D Blaschko ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

African American ◽

African American Men ◽

Treatment Decision ◽

Provider Communication ◽

Newly Diagnosed ◽

Treatment Decision Making ◽

Ethnographic Approach ◽

Patient Provider Communication

IntroductionIn the USA, African American men bear a disproportionate burden of prostate cancer (PCa) compared with all other groups, having a higher incidence and mortality, poorer quality of life and higher dissatisfaction with care. They are also less likely to receive guideline-concordant treatment (eg, undertreatment of aggressive disease). Inadequate patient–provider communication contributes to suboptimal care, which can be exacerbated by patients’ limited health literacy, providers’ lack of communication skills and time constraints in low-resource, safety net settings. This study is designed to examine the communication experiences of African American patients with PCa as they undertake treatment decision-making.Methods and analysisUsing an ethnographic approach, we will follow 25 African American men newly diagnosed with PCa at two public hospitals, from diagnosis through treatment decision. Data sources include: (1) audio-recorded clinic observations during urology, radiation oncology, medical oncology and primary care visits, (2) field notes from clinic observations, (3) patient surveys after clinic visits, (4) two in-depth patient interviews, (5) a provider survey, and (6) in-depth interviews with providers. We will explore patients’ understanding of their diagnoses and treatment options, sources of support in decision-making, patient–provider communication and treatment decision-making processes. Audio-recorded observations and interviews will be transcribed verbatim. An iterative process of coding and team discussions will be used to thematically analyse patients’ experiences and providers’ perspectives, and to refine codes and identify key themes. Descriptive statistics will summarise survey data.Ethics and disseminationTo our knowledge, this is the first study to examine in-depth patient–provider communication among African American patients with PCa. For a population as marginalised as African American men, an ethnographic approach allows for explication of complex sociocultural and contextual influences on healthcare processes and outcomes. Study findings will inform the development of interventions and initiatives that promote patient-centred communication, shared decision-making and guideline-concordant care. This study was approved by the University of California San Francisco and the Alameda Health System Institutional Review Boards.

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Patient-centered pathology reports for breast cancer care: Interim results of a randomized pilot study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19157 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19157-e19157

Author(s):

John L. Gore ◽

Sara Javid ◽

Elizabeth Austin ◽

Mark Kilgore ◽

Elizabeth Parker ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Cancer Care ◽

Self Efficacy ◽

Pathology Report ◽

Shared Decision ◽

Patient Centered ◽

Standard Report ◽

Pathology Reports

e19157 Background: Receiving a new cancer diagnosis event is a daunting event, quickly followed by complex decision-making between patients and care teams. In order for patients to fully engage in shared decision-making with their providers, they must have access to understandable, patient-centered information that empowers them to take an active role. Yet cancer pathology reports currently target providers and are marred by complex medical terminology. To address this gap, we designed and piloted patient-centered pathology reports (PCPRs) for breast cancer surgical pathology. We hypothesized that PCPRs would result in patients having greater pathology knowledge and decisional self-efficacy. Methods: PCPRs were designed with continuous guidance from breast surgeons, pathologists, and patient advocates with the goal of providing a supplemental tool to translate standard pathology reports to layman’s terms for patients. PCPRs were built into the electronic medical record and tested for quality and accuracy over a 4-month period. Participants were recruited from the clinical practices of two breast surgeons and randomized to receive either the PCPR and standard pathology report or standard pathology report alone. Patients were surveyed at baseline and one month after to assess their breast cancer knowledge and ratings of confidence (scale 1-5) and decisional self-efficacy (DSE) for treatment decision-making (scale 0-100). Results: Of a planned 40 pilot patients, 30 have been enrolled, randomized (20 standard report patients, 10 PCPR patients), and have follow up data. Evaluation of patient knowledge showed that compared with the control group, patients who received a PCPR had similar knowledge of the important elements of their report (p = 0.10-p = 0.69) with greater specificity for those report elements. Confidence in their diagnosis slightly favored PCPR recipients (confidence rating mean 4.00 vs. 3.77 for control patients, p = 0.67). Patients receiving the PCPR had better DSE immediately after receipt of the pathology report than standard report patients (DSE 96.0 vs. 82.2, respectively, p = 0.05) with a more attenuated DSE difference one month later (DSE 87.3 vs. 79.2, respectively, p = 0.35). Conclusions: This interim analysis suggests that providing breast cancer patients with patient-centered pathology reports may contribute to an improved ability to engage in shared decision-making. Confirming these results with complete pilot data could inform a larger multicenter study to validate their effectiveness in clinical cancer care.

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Facilitating treatment decision making, adjustment, and coping in men newly diagnosed with prostate cancer

PsycEXTRA Dataset ◽

10.1037/e447342006-001 ◽

2001 ◽

Author(s):

Michael A. Diefenbach

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Treatment Decision ◽

Newly Diagnosed ◽

Treatment Decision Making ◽

And Coping

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Multisite Quality Improvement Study of a Patient-Pathologist Consultation Program

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa202 ◽

2020 ◽

Author(s):

Rachel Jug ◽

Adam L Booth ◽

Anne F Buckley ◽

Jordan Newell ◽

Joshua Kesterson ◽

...

Keyword(s):

Quality Improvement ◽

Health Condition ◽

Further Education ◽

Pathology Report ◽

Newly Diagnosed ◽

Patient Centered ◽

Care Experience ◽

Clinical Encounters ◽

Written Information ◽

Experience Questionnaire

Abstract Objectives The aim of this multisite quality improvement study was to evaluate patients’ experiences with the patient-centered pathology (PCP) consultation program and to determine whether PCP enhanced their care experience. Methods Patients were invited to attend PCP consultations to review their pathology report and slides and have their questions answered by the pathologist privately, with the option to attend the appointment with family members or friends for support. A patient experience questionnaire (PEQ) was administered to patients, who participated voluntarily in the PCP, and survey data were collected and stored in REDCap. Statistical analysis was performed using SAS 9.4 (SAS Institute). Results Sixty-seven patients (95.5% female) aged 18 to 84 years across 4 institutions completed the PEQ. Overall, 58% and 15.8% of patients had breast and brain tumors, respectively, and 59.7% of tumors were newly diagnosed. Most patients thought it was important for them to learn as much as they could about their health condition. However, the majority of patients reported some degree of difficulty learning about their health condition based on written information, despite 97% having completed high school and/or further education. The majority of patients rated their pathologist as “excellent” across communication metrics. Ultimately, 100% of respondents were satisfied, found their visits to be useful, and would recommend the PCP to other patients. Conclusions Patients found that personalized clinical encounters with pathologists improved their understanding of their health condition and their satisfaction with their care experience. Patients thought pathologists communicated respectfully, effectively, and empathetically.

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Modified Predictive Model and Nomogram by Incorporating Prebiopsy Biparametric Magnetic Resonance Imaging With Clinical Indicators for Prostate Biopsy Decision Making

Frontiers in Oncology ◽

10.3389/fonc.2021.740868 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jin-feng Pan ◽

Rui Su ◽

Jian-zhou Cao ◽

Zhen-ya Zhao ◽

Da-wei Ren ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Prediction Model ◽

Prostate Biopsy ◽

Clinical Decision Making ◽

Prediction Models ◽

Elevated Serum ◽

Training Group ◽

Validation Group ◽

Clinical Indicators

PurposeThe purpose of this study is to explore the value of combining bpMRI and clinical indicators in the diagnosis of clinically significant prostate cancer (csPCa), and developing a prediction model and Nomogram to guide clinical decision-making.MethodsWe retrospectively analyzed 530 patients who underwent prostate biopsy due to elevated serum prostate specific antigen (PSA) levels and/or suspicious digital rectal examination (DRE). Enrolled patients were randomly assigned to the training group (n = 371, 70%) and validation group (n = 159, 30%). All patients underwent prostate bpMRI examination, and T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences were collected before biopsy and were scored, which were respectively named T2WI score and DWI score according to Prostate Imaging Reporting and Data System version 2 (PI-RADS v.2) scoring protocol, and then PI-RADS scoring was performed. We defined a new bpMRI-based parameter named Total score (Total score = T2WI score + DWI score). PI-RADS score and Total score were separately included in the multivariate analysis of the training group to determine independent predictors for csPCa and establish prediction models. Then, prediction models and clinical indicators were compared by analyzing the area under the curve (AUC) and decision curves. A Nomogram for predicting csPCa was established using data from the training group.ResultsIn the training group, 160 (43.1%) patients had prostate cancer (PCa), including 128 (34.5%) with csPCa. Multivariate regression analysis showed that the PI-RADS score, Total score, f/tPSA, and PSA density (PSAD) were independent predictors of csPCa. The prediction model that was defined by Total score, f/tPSA, and PSAD had the highest discriminatory power of csPCa (AUC = 0.931), and the diagnostic sensitivity and specificity were 85.1% and 87.5%, respectively. Decision curve analysis (DCA) showed that the prediction model achieved an optimal overall net benefit in both the training group and the validation group. In addition, the Nomogram predicted csPCa revealed good estimation when compared with clinical indicators.ConclusionThe prediction model and Nomogram based on bpMRI and clinical indicators exhibit a satisfactory predictive value and improved risk stratification for csPCa, which could be used for clinical biopsy decision-making.

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Racial differences in veterans’ response to a standard vs. patient-centered decision aid for prostate cancer: Implications for decision making in African American and White men

Patient Education and Counseling ◽

10.1016/j.pec.2020.06.004 ◽

2020 ◽

Vol 103 (12) ◽

pp. 2460-2467

Author(s):

Aisha T. Langford ◽

Laura D. Scherer ◽

Peter A. Ubel ◽

Margaret Holmes-Rovner ◽

Karen A. Scherr ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

African American ◽

Racial Differences ◽

Decision Aid ◽

White Men ◽

Patient Centered

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Is there a correlation between the aggressiveness of chronic asymptomatic prostatitis NIH category IV and the Gleason score in patients with prostate cancer?

Canadian Urological Association Journal ◽

10.5489/cuaj.6284 ◽

2019 ◽

Vol 14 (11) ◽

Author(s):

Erdogan Aglamis ◽

Cavit Ceylan ◽

Mustafa Akin

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Gleason Score ◽

Needle Biopsy ◽

Newly Diagnosed ◽

Prostate Needle Biopsy ◽

Retrospective Design ◽

Biopsy Specimens ◽

Grade 3 ◽

Prostatic Inflammation

Introduction: We evaluated the correlation between the International Society of Urological Pathology (ISUP) grades and the aggressiveness grades of prostate inflammation in newly diagnosed prostate cancer patients with chronic asymptomatic prostatitis National Institiutes of Health (NIH) category IV (CAPNIHIV). Methods: The study comprised 357 consecutive patients with prostate cancer in whom a cancer diagnosis had been made via a prostate needle biopsy. Histological sections of the prostate biopsy specimens of the patients were reviewed and scored. Prostatic inflammation was scored using the aggressiveness grade of inflammation. The associations between the ISUP grades and the aggressiveness grades of inflammation were analyzed using logistic regression. The limitations of the study were its retrospective design and the limited number of cases. Results: In 110 (31%) patients, CAPNIHIV was detected: 56 (51%) patients had a grade 0 aggressiveness score, 34 (31%) patients had a grade 1 aggressiveness score, and 20 (18%) patients had a grade 2 aggressiveness score. The patients who had prostatic inﬂammation had a 1.65 times (95% conﬁdence interval [CI] 1.05–2.61) greater likelihood of a high ISUP grade (grade ≥3) compared with the patients who did not have prostatic inﬂammation. The association between the ISUP grade and the aggressiveness grade of inflammation was more pronounced for a grade 2 aggressiveness score (n= 20; odds ratio 2.97; 95% CI 1.14–7.71). Conclusions: In prostate cancer patients with CAPNIHIV, there was a positive correlation between the inflammation aggressiveness grade and the ISUP grade. The aggressiveness of intraprostatic inflammation may be an important morphological factor affecting the Gleason score.

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