Work

Reply to Editorial Comment: Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study

Year: 2024

Type: letter

Abstract: We appreciate the kind comments by Dr. Obiora and Dr. Jacobs on our article examining nonclinical factors that affect physician decision-making for patients with advanced prostate cancer. Patient factors, such as race, geographic distribution, and physician specialty have been shown to create treatment variation for these patients.1 Provider insights, however, regarding the factors that create treatment disparities for patients with advanced prostate cancer have been woefully understudied. Our article sheds light on this knowledge gap by revealing 3 themes and 17 domains that influence physician decision-making.2 While we attempted to enroll physicians from all regions of the United States, we acknowledge that the use of a snowball technique likely contributed to lower enrollment from the western part of the country. Although we recruited fewer rural providers in this study as well, it is important to consider that 76% of rural counties in the United States do not have a practicing urologist.3 This does not mean that we did not sample urologists that take care of rural patients, however, as it is unfortunately common that patients from rural areas have to travel to suburban or urban health care centers for urological care. As such, we agree that the absence of rural urologists likely did not have a profound impact on our results as geographical distribution of the patient with prostate cancer likely has a more significant effect than the practice location of the urologist. We agree with Dr. Obiora and Dr. Jacobs that the impact of the prior authorization process on the treatment of patients with advanced prostate cancer is profound and disheartening.4 It is evident that the prior authorization process affects treatment decisions, consumes considerable practice resources, and delays treatment.2 We hope that this study will draw attention to these challenges, as well as other patient, clinician, and practice factors that affect decision-making, thus contributing to clinicians not being able to successfully offer patients certain treatment types, unwarranted variation, and health care disparities. This work will also hopefully lay the groundwork for additional research and intervention development, allowing for impactful change for patients and clinicians in the future.

Source: JU Open Plus

DOI: 10.1097/ju9.0000000000000130