Concordance between patient-reported and physician-reported sexual function after radical prostatectomy.

Urol Oncol 2018 02 12;36(2):80.e1-80.e6. Epub 2017 Oct 12.

Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY. Electronic address:

Purpose: Accurately tracking health-related quality-of-life after radical prostatectomy is critical to counseling patients and improving technique. Physicians consistently overestimate functional recovery. We measured concordance between surgeon-assessed and patient-reported outcomes and evaluated a novel method to provide feedback to surgeons.

Materials And Methods: Men treated with radical prostatectomy self-completed the International Index of Erectile Function-6 questionnaire at each postoperative visit. Separately, physicians graded sexual function on a 5-point scale. International Index of Erectile Function -6 score<22 and grade ≥3 defined patient-reported and physician-assessed erectile dysfunction (ED), respectively. Feedback on concordance was given to physicians starting in May 2013 with the implementation of the Amplio feedback system. Chi-square tests were used to assess agreement proportions and linear regression to evaluate changes in agreement after implementation.

Results: From 2009 to 2015, 3,053 men completed at least 1 postprostatectomy questionnaire and had a concurrent independent physician-reported outcome. Prior to implementation of feedback in 2013, patients and physicians were consistent as to ED 83% of the time; in 10% of cases, physicians overestimated function; in 7% of cases, physicians, but not patients reported ED. Agreement increased after implementation of feedback but this was not statistically significant, likely owing to a ceiling effect. Supporting this hypothesis, increase in agreement postfeedback was greater during late follow-up (≥12mo), where baseline agreement was lower compared to earlier follow-up.

Conclusions: Agreement was higher than expected at baseline; implementation of feedback regarding discrepancies between patient-reported and physician-assessed outcomes did not further improve agreement significantly. Our observed high rate of agreement may be partly attributed to our institutional practice of systematically capturing patient-reported outcomes as part of normal clinical care.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urolonc.2017.09.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309189PMC
February 2018
14 Reads

Publication Analysis

Top Keywords

radical prostatectomy
12
sexual function
8
international erectile
8
novel method
4
method provide
4
feedback surgeonsmaterials
4
methods men
4
surgeonsmaterials methods
4
evaluated novel
4
provide feedback
4
outcomes evaluated
4
functional recovery
4
overestimate functional
4
consistently overestimate
4
recovery measured
4
measured concordance
4
patient-reported outcomes
4
concordance surgeon-assessed
4
men treated
4
self-completed international
4

Similar Publications