Why patient preferences remain overlooked in prostate cancer decisions

In this interview, Nadine Friedrich, MD, and Timothy J. Daskivich, MD, MSHPM, discuss their research on shared decision-making (SDM) in urologic practice, highlighting significant gaps in how clinicians engage patients during consultations.¹ Friedrich notes that one of the most prominent deficiencies is physicians’ failure to clarify the structure of the decision-making process. Many clinicians do not explain how the consultation will unfold or clearly define the respective roles of physician and patient. Without this framework, patients may feel uncertain about how to participate or what is expected of them.

Another major shortcoming is the lack of attention to patient preferences and values. Friedrich’s team found that such discussions occurred in only about one-third of consultations, with prior studies showing even lower rates of eliciting patient values. She emphasizes that this represents a systemic issue, as there is no consistent roadmap guiding physicians through effective SDM. Furthermore, analyses of patient contributions reveal that patients themselves spend very little time articulating their values and preferences, suggesting a missed opportunity for meaningful engagement.

Daskivich expands on these findings by noting that traditional models of care have been paternalistic, with physicians making decisions unilaterally. Although some patients may expect this approach, the field is striving toward a model where doctors present expert knowledge and treatment options, whereas patients contribute their personal goals, values, and concerns. Aligning these perspectives requires physicians to be proactive in eliciting patient input early in the consultation.

Both experts stress that improving SDM requires cultural and structural changes in practice, moving away from one-sided decision-making toward a collaborative process. By clearly defining roles, explaining the decision pathway, and deliberately incorporating patient preferences, clinicians can better support informed, patient-centered 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