Quality of physician-patient relationships is associated with the influence of physician treatment recommendations among patients with prostate cancer who chose active surveillance

Objective: With growing evidence that some men with prostate cancer (PCa) may be overtreated, clinicians need greater knowledge of the factors that influence uptake of treatment recommendations in general, and specifically, uptake of active surveillance in patients for whom this is an appropriate treatment option. The objective of this study was to test the role of the quality of the physician-patient relationship in the choice to be followed by active surveillance, rather than receive definitive therapy (e.g., surgery and radiation). We hypothesized that patients would have been more influenced by their physicians' treatment recommendations to the degree that they held more positive perceptions of their relationship with their physicians, independent of treatment recommended. Methods and materials: Patients with PCa (n = 120) being followed with active surveillance at a comprehensive cancer center completed self-report assessments of their treatment decision-making process. Generalized estimating equations were used to model the association between participants' perceptions of their relationships with their physicians and influence of these physicians' recommendations on their treatment decision. Results: After controlling for the type of treatment recommended, Gleason score, and education, 3 predictors, trust in the physician, perceived closeness with the physician, and the degree to which the physician shared control over treatment decision making, were associated with greater influence of physician's treatment recommendation. Receiving a recommendation for active surveillance, compared with definitive therapy, was also associated with higher perceived trust, closeness, shared control over treatment decision making, lower likelihood of having been treated poorly by a physician, and greater influence of physician's treatment recommendation. Conclusions: There is increasing concern that patients with relatively less aggressive PCa, older age, or serious comorbidities are being unnecessarily treated with surgery or radiation, putting them at risk for side effects, and contributing to high health care costs. When active surveillance is an appropriate course of treatment, the quality of patients' relationships with their physicians may be a determinant of following a recommendation for active surveillance. Results may have implications for treatment uptake in general, indicating that the quality of the physician-patient relationship, including trust, closeness, shared decision making all elements of patient-centered care-may be important motivators of treatment adoption and adherence. (C) 2014 Elsevier Inc. All rights reserved.