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


Authors: Thong, A. E.; Poon, B. Y.; Lee, J. K.; Vertosick, E.; Sjoberg, D. D.; Vickers, A. J.; Ehdaie, B.
Article Title: Concordance between patient-reported and physician-reported sexual function after radical prostatectomy
Abstract: 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 (≥12 mo), 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. © 2018 Elsevier Inc.
Keywords: aged; middle aged; recovery of function; pathophysiology; linear models; quality of life; cohort studies; cohort analysis; questionnaires; postoperative complication; postoperative complications; prostatic neoplasms; questionnaire; prostatectomy; prostate tumor; chi-square distribution; erectile dysfunction; convalescence; statistical model; outcomes; chi square distribution; procedures; humans; human; male; surveys and questionnaires
Journal Title: Urologic Oncology: Seminars and Original Investigations
Volume: 36
Issue: 2
ISSN: 1078-1439
Publisher: Elsevier Inc.  
Date Published: 2018-02-01
Start Page: 80e.1
End Page: 80.e6
Language: English
DOI: 10.1016/j.urolonc.2017.09.017
PUBMED: 29031420
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Andrew J Vickers
    556 Vickers
  2. Daniel D. Sjoberg
    138 Sjoberg
  3. Behfar Ehdaie
    73 Ehdaie
  4. Jessica Bing Ying Poon
    15 Poon
  5. Justin Ka-Pun Lee
    10 Lee
  6. Alan Eih Chih Thong
    4 Thong