Who you see last matters: The recency effect in treatment decision-making for localized prostate cancer.

OBJECTIVE To evaluate the impact of the sequence of specialist physician consultations (e.g., urology, radiation oncology) on definitive treatment choices in newly diagnosed prostate cancer patients. METHODS Using electronic medical records from two US healthcare systems, we examined the number and order of specialty appointments and final treatment decisions for patients newly diagnosed with localized prostate cancer. We analyzed data using Fisher's exact and ANOVA tests. RESULTS Patients (N=254) had a mean age of 64±6.86 years and PSA 6.86±3.81 ng/mL. All patients (100%, n=254) consulted with a urologist for their first treatment consultation. Most patients (72.0%, n=183) subsequently consulted with a radiation oncologist. Final treatment decisions included surgery (33.5%; n=85), radiation therapy (48.8%; n=124), and active surveillance (17.7%;(n=45). Among patients who consulted with more than one physician (n=183), the specialty of the last physician was significantly associated with the final treatment chosen (p<.001). Most patients who consulted with a radiation oncologist last opted for radiation (75.0%, 96/128). When urology was the final specialty visited (either exclusively or after a radiation oncologist consultation), 60.0% (33/55) selected surgery or active surveillance. CONCLUSIONS A recency effect was observed, as patients' treatment choices strongly aligned with the specialty of the last physician consulted. To ensure patients receive care concordant with their personal preferences while promoting optimal cancer control, multidisciplinary consulting models are recommended, which may provide balanced treatment recommendations and enhance patient satisfaction.