Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study.

Introduction: Promising new treatments exist for advanced prostate cancer. Decision-making is complicated: there is minimal comparative effectiveness data; differing routes of administration, drug mechanisms-of-action and side effects; and significant price differences. These challenges contribute to variations in care and quality, treatment disparities, and lack of concordance with patient values. The aim of this study was to examine physician perspectives of factors influencing decision-making for first-line advanced prostate cancer treatments. Methods: We conducted a qualitative descriptive study of physicians who treat patients with advanced prostate cancer from 09/2021-06/2022. Participants were purposively sampled from across the United States. Results: Twenty-seven physicians participated. We identified seventeen domains and three overarching themes affecting physician decision-making for advanced prostate cancer care. The themes were: 1) physician and practice factors impact prescribing decisions, 2) health practice resource availability affects the likelihood patients will receive the recommended treatment, and that the treatment will be in-line with patients' values and 3) patient non-clinical factors influence physician decision-making, but patient values could be better incorporated into prescribing decisions. Based upon the analyses, we constructed a preliminary framework of clinician decision-making for advanced prostate cancer. Conclusions: Physicians perceive non-clinical patient, physician, and practice factors impact decision-making. These factors, therefore, must be considered when implementing programs to optimize a physician's ability to provide quality cancer care, reduce health care disparities and patient financial burden and provide patient goal-concordant care. The preliminary theoretical model of clinician decision-making for advanced prostate cancer care may also be used to inform these efforts.