When doctors discuss treatment options with patients, they tend to be more enthusiastic about treatments that are readily available, according to new research from Duke University's Fuqua School of Business.
Professor Peter Ubel found robotic surgery was described in more positive terms to prostate cancer patients at hospitals where it was available than at facilities where it was not.
"Patients need accurate and unbiased information about their treatment choices, regardless of what is available where their appointment is taking place," Ubel said. "It's the only way they can make fully informed decisions."
The research, "Treatment Availability Influences Physicians' Portrayal of Robotic Surgery During Clinical Appointments," is newly published in the journal Health Communications. Ubel worked with Duke M.D./Ph.D. student Karen Scherr. Dr. John Wei of the University of Michigan and Lillie Williamson of the University of Illinois also contributed.
The team reviewed the transcripts of 252 appointments that took place between 2008 and 2012, during which prostate cancer treatment was discussed for the first time with a patient. The data was collected as part of a larger study of patient-doctor interactions, which was led by principal investigator Professor Angela Fagerlin of the University of Utah. The appointments studied for this research occurred at four Veterans Affairs medical centers, one of which, the largest, did not offer robotic surgery.
"We found that physicians describe robotic prostatectomy more positively when it's available," Scherr said. "Importantly, this seems to be happening because of concern about patients' emotions when they find robotic surgery isn't available. I don't think physicians are doing this for any malicious reason. It's just very difficult to tell people about something good if it's not available, and if it is available you want to tell people it's good."
Because VA physicians are salaried employees, the researchers were able to rule out financial incentives as a factor in how the treatments were described. Scherr said the findings reveal a previously unstudied way in which doctors could be contributing to the increasing demand for robotic surgery.
"We know the media does a lot of direct-to-consumer advertising, and how that may be contributing to high healthcare costs," Scherr said. "But we didn't really know how physicians might be contributing to it in their conversations."
The research also signals another potential source of patient dissatisfaction, which affects financial reimbursements for doctors and hospitals, Scherr said.
"We are exploring why patients may not be satisfied, and one reason may be inflated expectations going into a procedure like robotic surgery," she said. "When physicians paint robotic surgery as this great thing, they may be disappointed."
Still, Scherr said it remains important for physicians to consider patient emotions when describing treatments.
"We need to understand how we can describe these treatment alternatives to patients in a more consistent way," she said, "but still address their concerns about treatment availability."
Funding for this research was provided by the U.S. Department of Veterans Affairs and the federal Medical Scientist Training Program.