Patient-Provider Communication, Treatment, and Survival in a Population-Based Cohort: The North Carolina-Louisiana Prostate Cancer Project

PURPOSE: Patient-provider communication (PPC) may be associated with receipt of definitive prostate cancer treatment and long-term outcomes. We examined these associations in a racially and geographically diverse population-based cohort. METHODS: We analyzed data for 2,258 Black and White participants enrolled in the North Carolina-Louisiana Prostate Cancer Project (2004-2009), with longitudinal vital status follow-up through 2020. PPC was measured using three subscales: contextual knowledge, communication content, and interpersonal treatment. We evaluated associations between PPC and receipt of definitive treatment and clinical outcomes. RESULTS: Communication content emerged as the most consistent PPC domain associated with clinical outcomes. Per five-point increase in communication content, the odds of receiving definitive treatment were higher for radiation therapy (odds ratio [OR], 1.49 [95% CI, 1.15 to 1.94]) and radical prostatectomy (OR, 1.73 [95% CI, 1.39 to 2.14]) compared with nondefinitive treatment. Communication content was also associated with greater likelihood of surgery within 3 months among prostatectomy recipients (OR, 1.66 [95% CI, 1.29 to 2.13]), with a directionally similar but nonsignificant association for radiation therapy. In competing-risk models, higher communication content was associated with lower prostate cancer-specific mortality (PCSM; subdistribution hazard ratio [sHR], 0.78 [95% CI, 0.61 to 0.99]). Associations varied by race and rurality, but formal interaction tests did not indicate effect measure modification. CONCLUSION: We found that higher communication content scores were associated with higher receipt of definitive treatment, shorter time to surgery, and lower PCSM. These findings highlight communication as a potentially modifiable component of the patient-provider encounter. Communication based on high informational quality is associated with long-term prostate cancer outcomes and represents a candidate target for future intervention research to improve prostate cancer care delivery.