{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:57:24Z","timestamp":1790791044862,"version":"4.1.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Prostate Cancer Prostatic Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clear communication of treatment risks and benefits is essential for shared decision making (SDM) in prostate cancer (PC). However, the quality of physician communication in real-world consultations remains poorly characterized. We assessed variation in quality of\u00a0risk communication in PC consultations and its association with patient, tumor, and provider characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We conducted a prospective cohort study of 50 PC consultations in a multispecialty\u00a0cohort of physicians\u00a0(3 urologists, 3 medical oncologists, 3 radiation oncologists), with an\u00a0analytic sample comprising 19,388 sentences. Transcripts were coded for five AUA-endorsed SDM content areas: cancer severity, life expectancy\u00a0(LE), oncologic endpoints, baseline function, and treatment side effects\u00a0(SEs). Analysts extracted all statements on these topics and scored communication quality using a validated 6-point scale (0\u2009=\u2009omission, 1 = name only, 2 = binary assessment of risk, 3 = imprecise quantification, 4 = specific quantification, and 5\u2009=\u2009patient-specific estimate). For each consultation, we calculated overall\u00a0(weighted average) and content-specific scores. We then conducted an\u00a0exploratory analysis of variation in communication quality by patient, tumor, and provider characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Communication quality varied substantially across consultations and content areas. Cancer severity had the highest median score (5, IQR\u00a04\u20135), indicating this information was typically communicated using\u00a0patient-specific estimates. LE had a median of 3 (IQR\u00a02\u20135), indicating imprecise quantification. Oncologic endpoints also had a median of 3 (IQR\u00a02\u20133). Baseline function and SEs had the lowest median of 1 (IQRs\u00a01\u20132 and 0\u20132), indicating name-only communication. Exploratory analyses revealed that overall communication quality was lower for Black patients, higher among urologists, increased with higher tumor risk, and varied by physician. Content-specific quality did not improve in subgroups where the content was clinically relevant (e.g., LE quality was not higher for patients with limited LE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Quality of physician communication in PC consultations varies across content areas and may be influenced by patient, tumor, and provider characteristics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41391-026-01159-8","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:21:21Z","timestamp":1790788881000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variation in quality of physician communication in prostate cancer consultations"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6713-0614","authenticated-orcid":false,"given":"Nadine A.","family":"Friedrich","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Luu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4286-2544","authenticated-orcid":false,"given":"Renning","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7757-7823","authenticated-orcid":false,"given":"Alexander","family":"Hernandez-Tirado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8104-6419","authenticated-orcid":false,"given":"Stephen J.","family":"Freedland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brennan","family":"Spiegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0751-5595","authenticated-orcid":false,"given":"Paul","family":"Kokorowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7540-3272","authenticated-orcid":false,"given":"Timothy J.","family":"Daskivich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"1159_CR1","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.urpr.2015.10.006","volume":"3","author":"DV Makarov","year":"2016","unstructured":"Makarov DV, Chrouser K, Gore JL, Maranchie J, Nielsen ME, Saigal C, et al. AUA white paper on implementation of shared decision making into urological practice. Urol Pract. 2016;3:355\u201363.","journal-title":"Urol Pract"},{"key":"1159_CR2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/JU.0000000000002757","volume":"208","author":"JAAG Eastham","year":"2022","unstructured":"Eastham JAAG, Barocas DA, et al. Clinically localized prostate cancer: AUA\/ASTRO guideline, part I: introduction, risk assessment, staging, and risk-based management. J Urol. 2022;208:10\u20138.","journal-title":"J Urol"},{"key":"1159_CR3","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1200\/JCO.1995.13.4.847","volume":"13","author":"TJ Whelan","year":"1995","unstructured":"Whelan TJ, Levine MN, Gafni A, Lukka H, Mohide EA, Patel M, et al. Breast irradiation postlumpectomy: development and evaluation of a decision instrument. J Clin Oncol. 1995;13:847\u201353.","journal-title":"J Clin Oncol"},{"key":"1159_CR4","first-page":"Cd001865","volume":"2013","author":"AG Edwards","year":"2013","unstructured":"Edwards AG, Naik G, Ahmed H, Elwyn GJ, Pickles T, Hood K, et al. Personalised risk communication for informed decision making about taking screening tests. Cochrane Database Syst Rev. 2013;2013:Cd001865.","journal-title":"Cochrane Database Syst Rev"},{"key":"1159_CR5","doi-asserted-by":"crossref","unstructured":"Hernandez-Tirado A, Zheng R, Luu M, Friedrich NA, Kokorowski P, Tan J, et al. Development of a Unified Framework for Evaluating the Quality of Physician Communication in Prostate Cancer Treatment Consultations. Med Decis Making. 2026;16:272989X261458355.","DOI":"10.1177\/0272989X261458355"},{"key":"1159_CR6","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/j.juro.2017.11.095","volume":"199","author":"MG Sanda","year":"2018","unstructured":"Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically localized prostate cancer: AUA\/ASTRO\/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol. 2018;199:683\u201390.","journal-title":"J Urol"},{"key":"1159_CR7","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1097\/JU.0000000000000287","volume":"202","author":"TJ Daskivich","year":"2019","unstructured":"Daskivich TJ, Thomas IC, Luu M, Shelton JB, Makarov DV, Skolarus TA, et al. External validation of the prostate cancer specific comorbidity index: a claims based tool for the prediction of life expectancy in men with prostate cancer. J Urol. 2019;202:518\u201324.","journal-title":"J Urol"},{"key":"1159_CR8","doi-asserted-by":"publisher","first-page":"2159","DOI":"10.1016\/j.pec.2017.06.030","volume":"100","author":"M Saheb Kashaf","year":"2017","unstructured":"Saheb Kashaf M, McGill ET, Berger ZD. Shared decision-making and outcomes in type 2 diabetes: a systematic review and meta-analysis. Patient Educ Couns. 2017;100:2159\u201371.","journal-title":"Patient Educ Couns"},{"key":"1159_CR9","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s12178-017-9409-4","volume":"10","author":"K Klifto","year":"2017","unstructured":"Klifto K, Klifto C, Slover J. Current concepts of shared decision making in orthopedic surgery. Curr Rev Musculoskelet Med. 2017;10:253\u20137.","journal-title":"Curr Rev Musculoskelet Med"},{"key":"1159_CR10","doi-asserted-by":"publisher","first-page":"e94670","DOI":"10.1371\/journal.pone.0094670","volume":"9","author":"MA Durand","year":"2014","unstructured":"Durand MA, Carpenter L, Dolan H, Bravo P, Mann M, Bunn F, et al. Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS One. 2014;9:e94670.","journal-title":"PLoS One"},{"key":"1159_CR11","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.pec.2009.03.005","volume":"77","author":"A Albada","year":"2009","unstructured":"Albada A, Ausems MG, Bensing JM, van Dulmen S. Tailored information about cancer risk and screening: a systematic review. Patient Educ Couns. 2009;77:155\u201371.","journal-title":"Patient Educ Couns"},{"key":"1159_CR12","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1001\/jamasurg.2021.5803","volume":"157","author":"TJ Daskivich","year":"2022","unstructured":"Daskivich TJ, Gale R, Luu M, Khodyakov D, Anger JT, Freedland SJ, et al. Patient preferences for communication of life expectancy in prostate cancer treatment consultations. JAMA Surg. 2022;157:70\u20132.","journal-title":"JAMA Surg"},{"key":"1159_CR13","doi-asserted-by":"publisher","first-page":"2731","DOI":"10.1016\/j.pec.2022.04.017","volume":"105","author":"RD Vromans","year":"2022","unstructured":"Vromans RD, Tillier CN, Pauws SC, van der Poel HG, van de Poll-Franse LV, Krahmer EJ. Communication, perception, and use of personalized side-effect risks in prostate cancer treatment-decision making: an observational and interview study. Patient Educ Couns. 2022;105:2731\u20139.","journal-title":"Patient Educ Couns"},{"key":"1159_CR14","doi-asserted-by":"crossref","unstructured":"Daskivich TJ, Luu M, Heard J, Thomas IC, Leppert JT. Overtreatment of prostate cancer among men with limited longevity in the active surveillance era. JAMA Intern Med. 2024;185:28\u201336.","DOI":"10.1001\/jamainternmed.2024.5994"},{"key":"1159_CR15","doi-asserted-by":"crossref","unstructured":"Daskivich TJ, Gale R, Luu M, Naser-Tavakolian A, Venkataramana A, Khodyakov D, et al. Variation in communication of competing risks of mortality in prostate cancer treatment consultations. J Urol. 2022:208:301\u20138.","DOI":"10.1097\/JU.0000000000002675"},{"key":"1159_CR16","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.2105\/AJPH.94.12.2084","volume":"94","author":"RL Johnson","year":"2004","unstructured":"Johnson RL, Roter D, Powe NR, Cooper LA. Patient race\/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94:2084\u201390.","journal-title":"Am J Public Health"},{"key":"1159_CR17","doi-asserted-by":"publisher","first-page":"e2144027","DOI":"10.1001\/jamanetworkopen.2021.44027","volume":"5","author":"K Yamoah","year":"2022","unstructured":"Yamoah K, Lee KM, Awasthi S, Alba PR, Perez C, Anglin-Foote TR, et al. Racial and ethnic disparities in prostate cancer outcomes in the veterans affairs health care system. JAMA Netw Open. 2022;5:e2144027.","journal-title":"JAMA Netw Open"},{"key":"1159_CR18","doi-asserted-by":"publisher","first-page":"1738","DOI":"10.1016\/j.pec.2019.04.023","volume":"102","author":"N Hagiwara","year":"2019","unstructured":"Hagiwara N, Elston Lafata J, Mezuk B, Vrana SR, Fetters MD. Detecting implicit racial bias in provider communication behaviors to reduce disparities in healthcare: challenges, solutions, and future directions for provider communication training. Patient Educ Couns. 2019;102:1738\u201343.","journal-title":"Patient Educ Couns"},{"key":"1159_CR19","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s40615-017-0350-4","volume":"5","author":"MJ Shen","year":"2018","unstructured":"Shen MJ, Peterson EB, Costas-Mu\u00f1iz R, Hernandez MH, Jewell ST, Matsoukas K, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Dispar. 2018;5:117\u201340.","journal-title":"J Racial Ethn Health Dispar"},{"key":"1159_CR20","doi-asserted-by":"publisher","first-page":"288.e7","DOI":"10.1016\/j.urolonc.2024.04.012","volume":"42","author":"NA Friedrich","year":"2024","unstructured":"Friedrich NA, Luu M, Gale R, Chaplin A, Ballas L, Sandler HM, et al. Variation in content discussed by specialty in consultations for clinically localized prostate cancer. Urol Oncol. 2024;42:288.e7\u2013e15.","journal-title":"Urol Oncol"},{"key":"1159_CR21","doi-asserted-by":"crossref","unstructured":"Zheng R, Friedrich NA, Luu M, Gale R, Khodyakov D, Freedland SJ, et al. Development and validation of a natural language processing system to assess quality of physician communication in prostate cancer consultations. Prostate Cancer Prostatic Dis. 2026;29:338\u201345.","DOI":"10.1038\/s41391-025-01011-5"},{"key":"1159_CR22","first-page":"71","volume":"31","author":"G Lopez-Garcia","year":"2026","unstructured":"Lopez-Garcia G, Xu D, Luu M, Zheng R, Daskivich TJ, Gonzalez-Hernandez G. Scoring physician risk communication in prostate cancer using large language models. Pac Symp Biocomput. 2026;31:71\u201384.","journal-title":"Pac Symp Biocomput"},{"key":"1159_CR23","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1161\/CIR.0000000000001162","volume":"148","author":"CR Dennison Himmelfarb","year":"2023","unstructured":"Dennison Himmelfarb CR, Beckie TM, Allen LA, Commodore-Mensah Y, Davidson PM, Lin G, et al. Shared decision-making and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2023;148:912\u201331.","journal-title":"Circulation"},{"key":"1159_CR24","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1056\/NEJMp1109283","volume":"366","author":"MJ Barry","year":"2012","unstructured":"Barry MJ, Edgman-Levitan S. Shared decision making \u2014 the pinnacle of patient-centered care. N Engl J Med. 2012;366:780\u20131.","journal-title":"N Engl J Med"},{"key":"1159_CR25","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.eururo.2013.09.046","volume":"65","author":"A Heidenreich","year":"2014","unstructured":"Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65:124\u201337.","journal-title":"Eur Urol"},{"key":"1159_CR26","unstructured":"National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae): Prostate Cancer. April 2026; (Version 5.2026)."}],"container-title":["Prostate Cancer and Prostatic Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41391-026-01159-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41391-026-01159-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41391-026-01159-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:21:24Z","timestamp":1790788884000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41391-026-01159-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":26,"alternative-id":["1159"],"URL":"https:\/\/doi.org\/10.1038\/s41391-026-01159-8","relation":{},"ISSN":["1365-7852","1476-5608"],"issn-type":[{"value":"1365-7852","type":"print"},{"value":"1476-5608","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"6 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}}]}}