Experts outline a roadmap for efficient and effective prostate cancer consultations

In this interview, Nadine Friedrich, MD, and Timothy J. Daskivich, MD, MSHPM, highlight the importance of systematically structuring shared decision-making in prostate cancer care. They emphasize that although many physicians cite time constraints as a barrier, essential elements of decision-making can be addressed in just a few sentences, provided clinicians know what to cover. They are co-authors of a recent study in Urology examining shared decision-making in prostate cancer.¹

Daskivich outlines a practical framework consisting of 5 key areas often overlooked in consultations: a general description of the decision-making process, clarification of patient and physician roles, establishing the order of decisions, and acknowledging potential decision-making hazards. He explains that these steps can be communicated efficiently by setting a clear roadmap for the discussion, clarifying roles, and sequentially framing the choices—from whether treatment is necessary, to broad categories of treatment, to specific modalities. This approach provides patients with structure and transparency, ensuring their values and preferences are integrated into evidence-based decisions.

Friedrich adds that these concise statements not only orient patients but also set the tone for collaborative engagement, making the consultation process less overwhelming. She suggests that training interventions such as audit-and-feedback, where physician consultations are recorded and reviewed against the framework, could help clinicians identify gaps in their approach. Additionally, using real-world prostate cancer scenarios as training tools could provide physicians with structured opportunities to reflect on and improve their consultations.

Both experts stress that the framework is not intended to overhaul physicians’ communication styles but rather to highlight overlooked areas. Daskivich notes that one key contribution of their research is empirically identifying what doctors commonly address, thereby allowing individual physicians to benchmark their own practices against established patterns. This reflective process, they argue, can enhance the quality and consistency of shared decision-making in prostate cancer care.

Friedrich is a post-doctoral research fellow in prostate cancer at Cedars-Sinai in Los Angeles, California, and Daskivich is an associate professor of urology and the director of Health Services Research for the Cedars-Sinai Department of Surgery.

REFERENCE

1. Friedrich NA, Kokorowski P, Luu M, et al. Topic mapping to inform content to discuss in shared decision-making for prostate cancer. Urology. 2025 May 28:S0090-4295(25)00511-4. doi:10.1016/j.urology.2025.05.053