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Research ArticleOriginal Research

How Men with Prostate Cancer Choose Specialists: A Qualitative Study

Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Michelle Ross, Archana Radhakrishnan and David Grande
The Journal of the American Board of Family Medicine March 2017, 30 (2) 220-229; DOI: https://doi.org/10.3122/jabfm.2017.02.160163
Tammy Jiang
From the Brown University School of Public Health, Providence, RI (TJ); the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (CHS, LC, DG); the Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD (CEP, AR); the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (MR); and the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (DG).
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Christian H. Stillson
From the Brown University School of Public Health, Providence, RI (TJ); the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (CHS, LC, DG); the Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD (CEP, AR); the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (MR); and the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (DG).
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Craig Evan Pollack
From the Brown University School of Public Health, Providence, RI (TJ); the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (CHS, LC, DG); the Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD (CEP, AR); the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (MR); and the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (DG).
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Linda Crossette
From the Brown University School of Public Health, Providence, RI (TJ); the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (CHS, LC, DG); the Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD (CEP, AR); the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (MR); and the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (DG).
MPH
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Michelle Ross
From the Brown University School of Public Health, Providence, RI (TJ); the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (CHS, LC, DG); the Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD (CEP, AR); the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (MR); and the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (DG).
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Archana Radhakrishnan
From the Brown University School of Public Health, Providence, RI (TJ); the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (CHS, LC, DG); the Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD (CEP, AR); the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (MR); and the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (DG).
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David Grande
From the Brown University School of Public Health, Providence, RI (TJ); the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (CHS, LC, DG); the Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD (CEP, AR); the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (MR); and the Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (DG).
MD, MPA
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Article Figures & Data

Tables

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    Table 1.

    Demographic Characteristics of Study Participants - Men with Recently Diagnosed Localized Prostate Cancer

    All Interview Participants (n = 47)*Active Patients (n = 10)*Partially Active Patients (n = 25)*Passive Patients (n = 12)*
    Age (mean, range)66.7 (59–86)70.6 (49 to 86)63.5 (50 to 76)70 (56 to 86)
    Educational Attainment N (%)
        High school or less15 (31.9%)1 (10%)8 (32%)6 (50%)
        Some college9 (19.1%)0 (0%)8 (32%)1 (8.3%)
        College or more22 (46.8%)9 (90%)9 (36%)4 (33.3%)
    Total Household Income N (%)
        <$50,00014 (29.8%)1 (10%)6 (24%)7 (58.3%)
        ≥$50,00030 (63.8%)8 (80%)18 (72%)4 (33.3%)
    Race N (%)
        White38 (80.9%)9 (90%)21 (84%)8 (66.7%)
        Black9 (19.1%)1 (10%)4 (16%)4 (33.3%)
    Employment Status N (%)
        Employed15 (31.9%)5 (50%)8 (32%)2 (16.7%)
        Unemployed2 (4.3%)1 (10%)1 (4%)0 (0%)
        Disabled4 (8.5%)0 (0%)2 (8%)2 (16.7%)
        Retired25 (53.2%)3 (30%)14 (56%)8 (66.7%)
    Insurance Status N (%)
        Medicare20 (42.6%)7 (70%)6 (24%)7 (58.3%)
        Medicaid2 (4.3%)0 (0%)1 (4%)1 (8.3%)
        Private25 (53.2%)3 (30%)18 (72%)4 (33.3%)
    • ↵* Certain demographic characteristics do not add up to the total number of participants because some participants did not provide all demographic information.

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    Table 2.

    Differences in How Men with Prostate Cancer Find Specialists

    ThemeRepresentative Quote
    Active Patients (n = 10)N (%)
    Selecting a Diagnosing Urologist
    ReferralReceived a referral from PCP but also researched/chose their own diagnosing urologist“I was the one who chose [the diagnosing urologist] … I looked up on the internet and chose my own specific [diagnosing] urologist.”5 (50%)
    Selecting a Specialist for Treatment
    ReferralReceived referral/treatment recommendation from diagnosing urologist but ultimately chose a different treating specialist“I just didn't feel comfortable with just saying okay, I'll have [my diagnosing urologist] do the surgery. Because the first question I asked him was how many surgeries have you done. He said about 200, okay? … And I saw a [different treating specialist] … and he's got a national reputation.”9 (90%)
    Online ResearchDid online research“I just looked at their [online] records and how deep a history they had doing this operation, and [the doctor] had done far more operations of this kind than the other fellow …”10 (100%)
    Consulted Friends-Family-Co-workersTalked to other men who had prostate cancer“I spoke to a number of people that I knew that had had similar cancer. I then had a choice to make in my own mind between two hospitals.”8 (80%)
    Second opinionSought second opinion after receiving a treatment recommendation/referral to another specialist from urologist“I get a second opinion about buying a garage door. Or when you buy a car, you go to a second or third dealer … that's just a smart way to do things. So when potentially your life is in the balance, why wouldn't you get a second or third opinion?”7 (70%)
    Partially Active Patients (n = 25)N (%)
    Selecting a Diagnosing Urologist
    ReferralWent to diagnosing urologist they were referred to by PCP without additional searches“No, I didn't know nothing about [the specialist] until I was told to go there. He's a really nice guy.”21 (84%)
    Existing UrologistSaw previous urologist they were referred to“Well, I already knew that guy from being there once or twice before, and he is–I really liked him. I had a lot of confidence in him.”3 (12%)
    Selecting a Specialist for Treatment
    ReferralReceived referral/treatment recommendation from diagnosing urologist but ultimately chose a different treating specialist“[My diagnosing urologist] referred me to a radiologist … I went to [a different healthcare facility] also–talked to a doctor there. That's when we decided to have prostate treatment.”5 (20%)
    Online ResearchDid online research“I went to the computer and looked things up about prostate cancer and everything.”7 (28%)
    Consulted Friends-Family-Co-workersTalked to friends-family-co-workers“Just word of mouth, knowing the [hospital] system. And my wife just told me, my son-in-law has been a patient for them … He just had good words to say about him. He had never had any problems with him.”5 (20%)
    Second OpinionSought second opinion after receiving a treatment recommendation/referral to another specialist from urologist“We just feel any time there's surgery involved, we should get a second opinion. It's just prudent.”13 (52%)
    Did not seek second opinion after receiving a treatment recommendation/referral to another specialist from urologist“We had no second opinion … I just want to get this over with.”12 (48%)
    Passive Patients (n = 12)N (%)
    Selecting a Diagnosing Urologist
    ReferralWent to diagnosing urologist they were referred to by PCP without additional searches“I just went with what my family doctor said … I just went with what was suggested, and I was satisfied.”9 (75%)
    Existing UrologistSaw previous urologist they were referred to by PCP“Because a few years back, I had a urology problem … And I called that particular practice, and he was the next doctor that had an appointment, so I saw him.”3 (25%)
    Selecting a Specialist for Treatment
    ReferralSaw only their diagnosing urologist and the treating specialists they were referred to by their diagnosing urologist for treatment“[My diagnosing urologist] sent me over to radiation oncology and that's why I saw [the radiation oncologist] … and then [the radiation oncologist] started doing the radiation.”12 (100%)
    Second OpinionDid not seek second opinion after receiving a treatment recommendation/referral to another specialist from urologist“I felt that–after my first meeting [with the urologist], … I didn't need a second opinion.”11 (91.6%)
    • * One passive patient sought a separate specialist to get a stress test because of his cardiac condition before undergoing surgery. The other 11 passive patients did not seek other specialists.

    • PCP, primary care physician.

    • View popup
    Table 3.

    Differences in What Men with Prostate Cancer Look for in a Treating Specialist

    ThemeRepresentative Quote
    Active Patients (n = 10)N (%)
    ExperienceExperience level“ … you want somebody that's done as many as you can find that seems like an okay guy because there's nothing like experience, and in surgery … So I had two doctors who had done thousands of these things.”7 (70%)
    ReputationReputation of doctor“I wanted to see the best person at [hospital] for the radiology. And obviously, it was the head of radiology. So, that's the reason I chose him. And it was a good choice … He was extremely good in his field.”8 (80%)
    Research“I wanted to be with a hospital that was up-to-date in the latest procedures, technologies, diagnostics, and I thought that both hospitals had that.”2 (20%)
    Bedside MannerBedside manner“I was happy when [my specialist] was very open and communicative. His communication skills were excellent … he said, prepare your questions. I'll answer any–all your questions.”6 (60%)
    Partially Active Patients (n = 25)N (%)
    ExperienceExperience level“Well, we looked him up on the internet. He got good patient ratings. And we had an initial meeting with him, and we felt we had a good rapport with him. We were comfortable with the way he laid things out, with his experience–he'd done 4000 of these kinds of surgeries.”9 (36%)
    ReputationReputation of facility“Well, one thing I look for in a doctor is where they work … one reason I like [this hospital] is because it's a teaching hospital … since this is a teaching hospital, most of the physicians are up to the moment with current trends and discoveries in the medical fields … ”8 (32%)
    Bedside MannerBedside manner“Gee, you know I guess just competence, somebody who gives you the feeling that they care. Like I said, I like somebody who spends a little bit of time with you. Like when I went to that urologist I felt like I was on the treadmill, an assembly line. When I got out of there, I bet nobody gets out of here without getting biopsy or another appointment.”12 (48%)
    TrustworthyTrustworthy“He didn't beat around the bush. You know what I mean? He more or less told you what was gonna happen, and that's what happened.”9 (36%)
    Passive Patients (n = 12)N (%)
    ExperienceExperience level“[My doctor] has been in this business for a long time, so. That's why I really went to him.”2 (16.7%)
    Bedside MannerBedside manner“Well, I like a doctor that I can sit down and talk to … a doctor who'll spend a little time with you … That is something that's important to me. Somebody I can talk to.”6 (50%)
    TrustworthyTrustworthy“Well, see I didn't know the difference between either doctor but, after he told me what he does and done this, I had everything in my heart to trust him … I felt safe and secure right … I never had a problem or anything, so I felt good.”5 (41.6%)
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The Journal of the American Board of Family     Medicine: 30 (2)
The Journal of the American Board of Family Medicine
Vol. 30, Issue 2
March-April 2017
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How Men with Prostate Cancer Choose Specialists: A Qualitative Study
Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Michelle Ross, Archana Radhakrishnan, David Grande
The Journal of the American Board of Family Medicine Mar 2017, 30 (2) 220-229; DOI: 10.3122/jabfm.2017.02.160163

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How Men with Prostate Cancer Choose Specialists: A Qualitative Study
Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Michelle Ross, Archana Radhakrishnan, David Grande
The Journal of the American Board of Family Medicine Mar 2017, 30 (2) 220-229; DOI: 10.3122/jabfm.2017.02.160163
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