Faculty Bibliography

OBJECTIVES/OBJECTIVE:To identify and explore barriers to, and enablers of, active surveillance (AS) in men with low-risk prostate cancer (LRPCa), as perceived by PCa clinicians. PATIENTS AND METHODS/METHODS:Urologists and radiation oncologists in Australia and New Zealand were purposively sampled for a cross-section on gender and practice setting (metropolitan/regional; public/private). Using a grounded theory approach, semi-structed interviews were conducted with participants. Interviews were coded independently by two researchers using open, axial, and selective coding. A constant comparative approach was used to analyse data as it was collected. Thematic saturation was reached after 18 interviews, and a detailed model of barriers to, and enablers of, AS for LRPCa, as perceived by clinicians was developed. RESULTS:A model explaining what affects clinician decision making regarding AS in LRPCa emerged. It was underpinned by three broad themes: (i) clinician perception of patients' barriers and enablers; (ii) clinician perception of their own barriers and enablers; and (iii) engagement with healthcare team and resource availability. CONCLUSIONS:Clinicians unanimously agree that AS is an evidence-based approach for managing LRPCa. Despite this many men do not undergo AS for LRPCa, which is due to the interplay of patient and clinician factors, and their interaction with the wider healthcare system. This study identifies strategies to mitigate barriers and enhance enablers, which could increase access to AS by patients with LRPCa.

OBJECTIVE:To characterize unmet sexual health resource needs and preferences for interventions to address unmet needs among female partners of patients with prostate cancer (PCa), given the significant negative impact of PCa on the sexual health of partners. METHODS:We conducted an exploratory sequential mixed methods study of female partners recruited from multiple U.S. clinical locations, websites, and support groups for caregivers. We first conducted semistructured in-depth interviews. Qualitative results informed development of a cross-sectional survey, which was administered to a larger sample of partners. RESULTS:Overall, 12 and 200 female partners participated in the qualitative and quantitative portions of the study. Major emergent themes from interviews were the benefits and drawbacks of technology-based interventions, the importance of sexual health resources throughout the PCa journey, and a desire for sexual health support groups that include partners. In the survey, the most common sexual health topics that partners wanted more information about were male libido problems (30.0%), erectile dysfunction (26.5%), and female libido and arousal problems (24.5%). Additionally, 41.5% wanted more information about sexual health websites, 35.0% about partners-only support groups, 29.5% about support groups for couples, and 23.5% about sexual medicine specialists. CONCLUSIONS:To our knowledge, this is the largest study to date on female partners' unmet sexual health resource needs and preferences for sexual health interventions. Partners prefer technology-based interventions, desire sexual health-focused support groups, and want more information about a variety of sexual issues and specialists who treat them.

Artificial intelligence (AI) chatbots are becoming a popular source of information but there are limited data on the quality of information on urological malignancies that they provide. Our objective was to characterize the quality of information and detect misinformation about prostate, bladder, kidney, and testicular cancers from four AI chatbots: ChatGPT, Perplexity, Chat Sonic, and Microsoft Bing AI. We used the top five search queries related to prostate, bladder, kidney, and testicular cancers according to Google Trends from January 2021 to January 2023 and input them into the AI chatbots. Responses were evaluated for quality, understandability, actionability, misinformation, and readability using published instruments. AI chatbot responses had moderate to high information quality (median DISCERN score 4 out of 5, range 2-5) and lacked misinformation. Understandability was moderate (median Patient Education Material Assessment Tool for Printable Materials [PEMAT-P] understandability 66.7%, range 44.4-90.9%) and actionability was moderate to poor (median PEMAT-P actionability 40%, range 0-40%The responses were written at a fairly difficult reading level. AI chatbots produce information that is generally accurate and of moderate to high quality in response to the top urological malignancy-related search queries, but the responses lack clear, actionable instructions and exceed the reading level recommended for consumer health information. PATIENT SUMMARY: Artificial intelligence chatbots produce information that is generally accurate and of moderately high quality in response to popular Google searches about urological cancers. However, their responses are fairly difficult to read, are moderately hard to understand, and lack clear instructions for users to act on.

BACKGROUND/UNASSIGNED:Tissue-based gene expression (genomic) tests provide estimates of prostate cancer aggressiveness and are increasingly used for patients considering or engaged in active surveillance. However, little is known about patient experiences with genomic testing and its role in their decision-making. METHODS/UNASSIGNED:We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- or favourable-intermediate-risk prostate cancer managed with active surveillance. We purposively sampled to include patients who received biopsy-based genomic testing as part of clinical care. The interview guide focused on experiences with genomic testing during patients' decision-making for prostate cancer management and understanding of genomic test results. We continued interviews until thematic saturation was reached, iteratively created a code key and used conventional content analysis to analyse data. RESULTS/UNASSIGNED: = 20) mean age was 68 years (range 51-79). At initial biopsy, 17 (85%) had a Gleason grade group 1, and 3 (15%) had a grade group 2 prostate cancer. The decision to undergo genomic testing was driven by both participants and physicians' recommendations; however, some participants were unaware that testing had occurred. Overall, participants understood the role of genomic testing in estimating their prostate cancer risk, and the test results increased their confidence in the decision for active surveillance. Participants had some misconceptions about the difference between tissue-based gene expression tests and germline genetic tests and commonly believed that tissue-based tests measured hereditary cancer risk. While some participants expressed satisfaction with their physicians' explanations, others felt that communication was limited and lacked sufficient detail. CONCLUSION/UNASSIGNED:Patients interact with and are influenced by the results of biopsy-based genomic testing during active surveillance for prostate cancer, despite gaps in understanding about test results. Our findings indicate areas for improvement in patient counselling in order to increase patient knowledge and comfort with genomic testing.

Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks-such as their extensive use and the relative ease it allows to share information quickly-facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give information prescriptions to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.

The Veterans Health Administration is chartered "to serve as the primary backup for any health care services needed…in the event of war or national emergency" according to a 1982 Congressional Act. This mission was invoked during the COVID-19 pandemic to divert clinical and research resources. We used an electronic mixed-methods questionnaire constructed using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation (COM-B) model for behavior change to study the effects of the pandemic on VHA researchers. The questionnaire was distributed electronically to 118 cancer researchers participating in national VHA collaborations. The questionnaire received 42 responses (36%). Only 36% did not feel that their research focus changed during the pandemic. Only 26% reported prior experience with infectious disease research, and 74% agreed that they gained new research skills. When asked to describe helpful support structures, 29% mentioned local supervisors, mentors, and research staff, 15% cited larger VHA organizations and 18% mentioned remote work. Lack of timely communication and remote work, particularly for individuals with caregiving responsibilities, were limiting factors. Fewer than half felt professionally rewarded for pursuing research related to COVID. This study demonstrated the tremendous effects of the COVID-19 pandemic on research activities of VHA investigators. We identified perceptions of insufficient recognition and lack of professional advancement related to pandemic-era research, yet most reported gaining new research skills. Individualizing the structure of remote work and ensuring clear and timely team communication represent high yield areas for improvement.

BACKGROUND:Podcasts, or episodic digital audio recordings, represent a novel way to reach large audiences for public education. Genetic evaluation has important implications for prostate cancer (PCa) care but is underutilized. We created a series of five podcasts about PCa genetics and tested their usefulness in raising awareness and providing education to lay audiences. METHODS:We recruited 157 men and women from the general public and 100 patients with PCa from across the U.S., who listened to a podcast and completed an online survey. The primary outcome was the perceived usefulness of the podcast (score ≥5 on a published 7-point Likert scale). Secondary outcomes were relevance to informational needs, satisfaction and ease of use, as well as genetic knowledge and attitudes toward genetic testing after listening to the podcasts. RESULTS:The podcasts were associated with high mean scores for perceived usefulness (5.6/7), relevance to informational needs (5.6/7), satisfaction (5.8/7), and ease of use (5.9/7). After listening to the podcasts, 80-100% correctly answered most key knowledge questions about PCa genetics, and 85% had a positive attitude toward genetic testing. On multivariable analysis, the perceived usefulness of the podcasts was higher among Black/Hispanic adults (p = 0.05) and those with a family history of PCa (p = 0.01). CONCLUSIONS:A podcast series on PCa genetics was perceived as useful and associated with high rates of knowledge for patients with PCa and the general public. Podcasts represent a promising new educational tool to raise awareness about PCa genetic evaluation, particularly for high-risk groups.

Environmental factors such as air pollution and climate change have far-reaching implications for human health, and increasing evidence supports a link between planetary health and many common urological conditions. We summarize these links and outline the data for some dietary and lifestyle changes that have joint benefits for both urological and planetary health. PATIENT SUMMARY: Steps to reduce our impact on the environment can also reduce the risk of urological cancers (bladder, prostate, and kidney cancers), urinary tract infections, kidney stones, and erectile dysfunction, and may have a positive impact on sperm quality. Simple steps such as reducing meat and dairy consumption, increasing exercise levels (e.g. through active commuting), and supporting the preservation of greenspace can benefit both personal health and the environment.

IMPORTANCE/UNASSIGNED:Consumers are increasingly using artificial intelligence (AI) chatbots as a source of information. However, the quality of the cancer information generated by these chatbots has not yet been evaluated using validated instruments. OBJECTIVE/UNASSIGNED:To characterize the quality of information and presence of misinformation about skin, lung, breast, colorectal, and prostate cancers generated by 4 AI chatbots. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study assessed AI chatbots' text responses to the 5 most commonly searched queries related to the 5 most common cancers using validated instruments. Search data were extracted from the publicly available Google Trends platform and identical prompts were used to generate responses from 4 AI chatbots: ChatGPT version 3.5 (OpenAI), Perplexity (Perplexity.AI), Chatsonic (Writesonic), and Bing AI (Microsoft). EXPOSURES/UNASSIGNED:Google Trends' top 5 search queries related to skin, lung, breast, colorectal, and prostate cancer from January 1, 2021, to January 1, 2023, were input into 4 AI chatbots. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcomes were the quality of consumer health information based on the validated DISCERN instrument (scores from 1 [low] to 5 [high] for quality of information) and the understandability and actionability of this information based on the understandability and actionability domains of the Patient Education Materials Assessment Tool (PEMAT) (scores of 0%-100%, with higher scores indicating a higher level of understandability and actionability). Secondary outcomes included misinformation scored using a 5-item Likert scale (scores from 1 [no misinformation] to 5 [high misinformation]) and readability assessed using the Flesch-Kincaid Grade Level readability score. RESULTS/UNASSIGNED:The analysis included 100 responses from 4 chatbots about the 5 most common search queries for skin, lung, breast, colorectal, and prostate cancer. The quality of text responses generated by the 4 AI chatbots was good (median [range] DISCERN score, 5 [2-5]) and no misinformation was identified. Understandability was moderate (median [range] PEMAT Understandability score, 66.7% [33.3%-90.1%]), and actionability was poor (median [range] PEMAT Actionability score, 20.0% [0%-40.0%]). The responses were written at the college level based on the Flesch-Kincaid Grade Level score. CONCLUSIONS AND RELEVANCE/UNASSIGNED:Findings of this cross-sectional study suggest that AI chatbots generally produce accurate information for the top cancer-related search queries, but the responses are not readily actionable and are written at a college reading level. These limitations suggest that AI chatbots should be used supplementarily and not as a primary source for medical information.