Login to Access Video or Poster Abstract: MP51-20
Sources of Funding: Society of Urologic Chairpersons and Program Directors

Introduction

Prostate cancer screening, diagnosis, and treatment may have adverse physical, psychological, and social implications for a patient and his family. Studies suggest that urologists do not foster reasonable expectations when communicating with patients about these issues, often leading to decisional regret. We performed a qualitative analysis of communication skills exhibited by 12 Urology housestaff, as they perform objective structured clinical encounters (OSCEs) with a virtual-world prostate cancer patient.

Methods

Following informed consent, 12 Urology housestaff participated in several scripted, virtual- world OSCEs with a 52 year old avatar patient. The 'Wizard of Oz” technique was used in which an unseen associate portrayed a standardized patient. The encounters included shared decision making and PSA screening, delivering a prostate cancer diagnosis, and informed consent for a prostatectomy. De-identified audio recordings of the encounters were analyzed using open, axial, and selective coding.

Results

Ten residents successfully elicited the patient’s perspective of PSA screening and all shared their knowledge of the benefits of screening. All housestaff indicated that PSA screening was controversial, and may result in over-diagnosis of prostate cancer. Only one discussed overtreatment. All housestaff discussed prognosis and that surgery and radiation could be used. None of the housestaff mentioned cryo-therapy or focal therapy, and 11/12 discussed active surveillance. In delivering informed consent, the disclosed risks of ED post prostatectomy ranged from “ a small percentage” to “50-70%.” With regard to additional adverse sexual effects: climacturia was mentioned by one resident, and none mentioned painful orgasm or penile shortening. Disclosed estimates for urinary incontinence varied from “<10%” to “almost all men have some degree of incontinence.” Most housestaff directed the patient to on-line decision support materials.

Conclusions

Physician communications with patients regarding prostate cancer screening, diagnosis, and treatment directly impact patient expectations and may contribute to decisional regret. Despite our small cohort of providers, we have shown that the majority of housestaff were able to discuss the technical aspects of PSA screening, prognosis, and treatment options in a fairly consistent manner. However, there was tremendous variability in the estimated risks and the impact of ED and incontinence. Other complications, such as penile shortening, orgasmic dysfunction, and climacturia were rarely discussed.

Funding

Society of Urologic Chairpersons and Program Directors