Patient-Provider Communication and Treatment Decision-Making among Latino Men with Prostate Cancer: A Qualitative Study

Abstract

Purpose:

Prostate cancer is the most commonly diagnosed cancer among Hispanic/Latino men in the United States, excluding skin cancers. However, little is known about how patient-provider communication influences prostate cancer knowledge and treatment decision-making specifically among Latino prostate cancer patients. Thus, we explored how patient-provider communication influences prostate cancer knowledge and treatment decision-making for Hispanic/Latino prostate cancer patients in Los Angeles County.

Methods:

We conducted semi-structured focus groups and individual interviews among 26 men who self-identified as Hispanic/Latino and were recently diagnosed with prostate cancer in Urology clinics at the USC Norris Comprehensive Cancer Center and the Los Angeles General Medical Center between May 2020 and October 2022.

Results:

Patient-provider relationships and communication significantly shaped treatment decision-making processes for prostate cancer. Positive patient-provider relationships, characterized by provider attentiveness, clear communication, and supplemental resources, facilitated shared decision-making and trust-based deference to physician expertise. Negative patient-provider relationships, characterized by provider inattentiveness, insufficient information, and blunt tone, resulted in authority-based deference. Three distinct decision-making processes were described by patients; shared decision-making, trust-based deference to the doctor’s treatment recommendations due to expertise and trust, and authority-based deference to the doctor’s “orders” due to the doctor’s authority.

Conclusion:

Our findings underscore the importance of patient-provider relationships to facilitate positive care experiences and shared decision-making processes among Latino prostate cancer patients.

INTRODUCTION

Prostate cancer is the most commonly diagnosed cancer among Hispanic/Latino (henceforth referred as Latino) men in the United States, excluding skin cancers [1–4]. In 2022, there were approximately 22,900 new prostate cancer cases, accounting for 25% of all new cancer diagnoses among Latino men [4]. Prostate cancer was the fourth leading cause of death in 2024 for Latino men, accounting for approximately 2,600 or 10% of estimated deaths [4]. Between 2018-2022, the age-adjusted mortality rate for Latino men was 15.4 per 100,000 [4]. Incidence of prostate cancer is lower among Latino men compared to non-Latino white men; however, Latino men are more likely to present with advanced-stage disease [2–5]. Disparities exist in prostate cancer screening and treatment for Latino men compared to non-Latino white men. For instance, Latino men have lower rates of prostate cancer screening compared to non-Latino white men [1,4,6]. Latino men receive lower rates of treatment and higher rates of treatment delays compared to non-Latino white men [5,7,8]. Latinos under active surveillance are less likely to receive medical monitoring [1] and more likely to be lost to follow up than non-Latino white men [9]. Prostate cancer survivors who are racial and ethnic minorities have been cited to have significantly worse patient care experiences compared to non-Latino survivors [10].

Improved patient-provider communication, shared decision making, and positive patient experiences are associated with adherence to treatment, medication compliance, improved cancer survival, improved quality of life, increased short-term prostate cancer knowledge, increased perception of being informed, and decreased decision regret and conflict for prostate cancer patients [11–13]. However, little is known about how patient-provider communication influences prostate cancer knowledge and treatment decision-making specifically among Latino prostate cancer patients. One prior qualitative study examined shared decision-making among underserved Latino men with prostate cancer in Los Angeles, finding that paternalistic patient-provider relationships were common and that both Spanish- and English-speaking men largely deferred to physician expertise in their treatment decisions though preferences for decision aid modality differed by language [14]. In our study, we sought to understand this issue further, examining in more detail the specific communication dynamics that shape how Latino men experience and navigate the decision-making process, and exploring how patient-provider communication differentially influence treatment decision-making among Latino prostate cancer patients in Los Angeles County.

METHODS

We conducted semi-structured focus groups and individual interviews with Latino prostate cancer patients in both English and Spanish to understand patient and physician interactions and how they impacted treatment decision making.

Patient recruitment.

We recruited men who self-identified as Hispanic/Latino who were recently diagnosed with prostate cancer in Urology clinics at the USC Norris Comprehensive Cancer Center and the Los Angeles General Medical Center between May 2020 and October 2022. All participants were recruited within 7 to 24 months (median 15 months) of receiving a prostate cancer diagnosis on prostate biopsy. Patients were recruited by mail and follow-up phone calls. We conducted 19 individual interviews in English or Spanish depending on the patient’s preferred language, which lasted between 30-60 minutes and were conducted over DialPad phone conferencing service. We also conducted three focus groups (2-3 participants in each). In total, we interviewed 26 Latino prostate cancer patients. Participants received a gift card upon completion of their interview or focus group. Data saturation was determined iteratively throughout the analytic process; recruitment and data collection continued until no new themes or concepts emerged and existing themes were consistently reinforced across interviews and focus groups. This study was approved by the University of Southern California’s Institutional Review Board (HS-20-00305).

Data collection.

The semi-structured interview/focus group guide included questions about overall knowledge of prostate cancer and prostate cancer treatment; provider communication about prostate cancer diagnosis, treatment, and follow-up care; specific cultural issues during cancer diagnosis and treatment including language barriers and family involvement; overall attitudes and beliefs about adherence to treatment and follow-up care; and recommendations for other prostate cancer patients.

Data analyses.

Interviews were audio-recorded and transcribed verbatim. Spanish interviews were translated to English by two native Spanish-speaking/bilingual study team members independently; any inconsistencies were resolved by a third member of the study team who was a native Spanish speaker. Using a deductive approach based on interview questions and overall study goals, the study team developed an initial codebook. All transcripts, including those translated from Spanish to English, were uploaded into Dedoose 9.0.90. An inductive, constant comparison approach, was then employed to uncover additional concepts and themes that emerged from the data. Two members of the study team independently coded a set of transcripts and collaboratively discussed codes and revised definitions to capture emergent themes. Coding disagreements were addressed through an iterative consensus process. After independent coding, coders met to review discrepancies, discuss interpretations, and refine code definitions. Disagreements were resolved through discussion until consensus was reached, with reference to the codebook and underlying data to ensure consistency and analytic rigor. Once all transcripts were coded, we explored connections among thematic categories and selected quotes that exemplified each theme. All participant names presented are pseudonyms.

RESULTS

We interviewed 26 Latino prostate cancer patients 53-85 years of age (Table 1). 61.5% were recruited from urology clinics at the USC Norris Comprehensive Cancer Center, while 38.5% were recruited from the Los Angeles General Medical Center. The majority (65%) were monolingual Spanish speakers and/or born outside the United States (73.1%). Out of the 19 immigrant patients, 78.9% were born in Mexico, 10.5% in Guatemala, 5.3% in El Salvador, and 5.3% in Venezuela. The majority of participants were married (69.2%) and retired (53.9%). Annual household income was predominately low, with 57.7% of participants reporting an annual household income below $20,000. Participants described interactions they had with their physicians at the time of diagnosis and the role that these providers played in their decision-making for prostate cancer treatment. Three overall themes emerged from the data: 1) positive patient-provider relationships; 2) negative patient-provider relationships; and 3) decision-making for prostate cancer treatment. The emergent themes are summarized in Figure 1 and illustrative quotes are presented in Table 2.

Table 1.

Participant characteristics (n=26)

Demographic characteristics	n (%) or Mean (SD; range)
Language Preference
Spanish	17 (65.4)
English	8 (30.8)
Bilingual	1 (3.9)
Nativity
Born in United States	7 (26.9)
Born Outside of United States	19 (73.1)
Country of Origin for Immigrants
El Salvador	1 (5.3)
Guatemala	2 (10.5)
Mexico	15 (78.9)
Venezuela	1 (5.3)
Age at Interview1	65.3 (8.42; range 53-85)
Recruitment Site
Keck Medical Center	16 (61.5)
Los Angeles County	10 (38.5)
Marital Status
Single	5 (19.2)
In a Committed Relationship	3 (11.5)
Married	18 (69.2)
Annual Household Income
Less than $10,000	7 (26.9)
$10,000 to $19,999	8 (30.8)
$20,000 to $29,999	2 (7.7)
$60,000 to $69,999	1 (3.9)
$70,000 to $79,999	1 (3.9)
$100,000 to $149,999	2 (7.7)
$150,000 or More	3 (11.4)
Missing	2 (7.7)
Employment Status
Employed	3 (11.5)
Self-Employed	2 (7.7)
Retired	14 (53.9)
Unemployed, Looking	2 (7.7)
Unable to Work	5 (19.2)

¹Missing age for one participant

Figure 1.

Emergent themes, subthemes, and descriptions

Table 2.

Illustrative quotes of themes and subthemes

Emergent Themes	Subthemes	Illustrative Quotes
Positive Patient-Provider Relationship	Attentiveness of Provider	“It was mostly a lot of conversations… they will talk to you and they will discuss everything with you in detail. There’s never any rush. They’ll sit down with you and they are looking through the computer and they’re checking everything. And they’re asking a lot of questions…Before you consider surgery, see someone that knows about brachytherapy because he [my doctor] described it in detail. Exactly what it did. The stages involved and everything. What to expect afterwards. And they are open to questions. So they will even discuss other treatments too. What’s involved and the advantages and disadvantages.” – Fernando, Spanish Speaker “There was a whole team between the oncologist and the pharmacists, the educational pharmacist. They were all great. It was like my own personal team of experts. I can ask them anything I want. They said the oncologist attacked the chemo. She explained that. And the educational pharmacist called me as far as what chemo would do to you. What food to eat and what not to eat. How I would feel… I thought they were great as far as them explaining anything I needed to know and if I had any questions they would answer them. And if they didn’t they would get back.” – Roman, English Speaker
	Clear Communication	“He [my doctor] gave me several options. What if he removed my prostate or if they gave me radiation. So we decided to have my prostate removed. But I received good information… And they explained to us [my family] exactly what was happening, what was going to happen… They explained the pros and cons to us. Everything that was going to happen. They said it may or may not be your case. But yes, they explained the whole situation to us perfectly well. How it was. What was going to happen. What consequences I was going to have. But I tell you, everything. Everything was explained to us well.” – Julian, Spanish Speaker “My doctor kind of went through the treatment plan as far as pre-surgery, surgery, post-surgery. This is what to expect. This is what’s gonna happen. This is how it’s gonna affect your sex life. And all of – some different aspects of your life. And I was okay with that. Not the best news to receive for a man. But I think that’s something that you have to face… For me it was kind of humbling because you’re not at your doctor’s mercy but you’re putting your life in their hands. So, I had faith in my doctor and his ability” – Eric, English Speaker
	Supplemental Resources	“My doctor supplemented all of this [treatment discussion] with a book that he sent me. About the care, the symptoms, the risk of prostate cancer. And it explains – it supplements you.” – Alfonso, English Speaker “He [my doctor] gave it [the book] to us so we could see how everything was…so that we would know how the whole process would be, how the cancer developed and everything. And how the operation would turn out and everything… it did help because when they gave me the news of the cancer, well I was scared, I was nervous. So then when I looked through the book… we [my Son and I] read it and it explained everything. The nerves went away”. - Humberto, Spanish Speaker
Negative Patient-Provider Relationship	Inattentiveness of Provider	“He [my doctor] didn’t really tell me anything. He just told the things how to get rid of it. The operation, the radiation, and the check every year. I think every six months, whatever. Every six months I think it is. That’s all he told me. He didn’t tell me anything else”. – Adrian, English Speaker “One doctor surprised me because she just told me hi and bye. I had to ask her, how are my antigens?… But if I don’t ask her, she doesn’t tell me anything… And they don’t take long. They have a lot of work. I don’t know. But also there, just like that. Tell me hi and bye. I mean, they don’t tell me anything. They don’t explain to me. I don’t know what’s going on.” – Jorge, Spanish Speaker
	Insufficient Information Shared	“By the time I had it [cancer], they said you have stage four. They said I recommend you go see your urologist. So I went to the urologist and he had it confirmed… He said okay you gotta do something or it’s gonna kill you. I suggest you read a book on surviving cancer. I did that. And then that was it. That was the only consultation. He said read this book and decide what to do. And you gotta decide quickly cause I guarantee that within a week it’s gonna break out and go all over your body. So I don’t know if he scared me into having it taken out. I didn’t think about going around and getting a second opinion”. – Gabriel, English Speaker “He [the doctor] didn’t tell me anything. The doctor told us you have cancer and he is going to operate on you. And that was it. Various doctors operated on me. They didn’t tell me why it occurred or how I got it… He didn’t tell me why it came out, nothing. You just have cancer and that’s it. They operated on me and that’s it… I would like him to tell me a way of how to control it. What occurred? Is it going to return? Or will I get it in another location? I don’t know what’s going to happen. They have never explained all that to me”. – Pablo, Spanish Speaker
	Tone of Provider	“He [the doctor] tells me, you know you have aggressive cancer. You have to tend to it quickly because if not, you can die. And that’s one of the things I didn’t like. That they are very crude to say things. Very crude… It was direct. You know what, you have cancer. You have to have surgery because your cancer is aggressive. If you don’t treat yourself something can happen. I mean, very crude. Too crude. And on top of that by phone. I mean, they didn’t even have the tact to adjust it to one and say, look, don’t worry. There are treatments. If they treat you quickly nothing will happen. But if they tell you that, they knock you out. They lower your self-esteem. I don’t know. You have many thoughts in your head”. – Julian, Spanish Speaker “He told me like this. I went with my wife only and he told me I have the results of your exam. You have cancer. That is how he told me… So from there he told me to handle your problem there are two things. One is surgery, another is that we burn you. That is how he told me. That we burn you. And then he told me what do you prefer? And I told him, well, I don’t know. But truthfully, he did behave a bit sharp. And so I was left with doubt”. – Javier, Spanish Speaker
Decision-Making for Prostate Cancer Treatment	Shared Decision-Making	“He [my doctor] basically explained to me all of my options… he pretty much recommended what the best course of action would be for my particular case. He explained to me the whole process and how long I was going to be out after surgery, how the surgery is done. He went through a lot of details which were very important to me”. – Ricardo, English Speaker “If you’ve never had cancer history in your family you don’t really have no clue what is really going on. It’s shocking to hear that so to me, I was devastated. But they [my doctors] are very knowledgeable. They explained everything to me left and right. They gave me the options and I chose the one that I thought was the right one”. – Diego, English Speaker
	Trust-Based Deference to the Doctor’s Treatment Recommendations Due to Experience and Trust	“I think that with what they tell me, I just have to follow instructions and do what they say. Because one doesn’t have that knowledge. And they do have it”. – Sebastian, Spanish Speaker “They [the doctors] are the ones who know, right? I would like if the solution is something like chemotherapy or an operation so that this problem is removed but hey, they are the ones who know, right?”. – Santiago, Spanish Speaker
	Authority-Based Deference to the Doctor’s “Orders” Due to Doctor’s Authority	“They [my doctors] did not ask me what I wanted to do. They only gave me what they told me. But they didn’t tell me that I have these options. They did not explain any of that”. – Martin, Spanish Speaker “He [my doctor] didn’t tell me anything, they only told me that they were doing a treatment. Basically, they did the radiation and afterwards he told me that they were going to give me hormones.” – Francisco, Spanish Speaker

Positive Patient-Provider Relationships.

When recounting stories of interactions with their provider, some patients discussed the positive experiences that they had with their provider during their diagnosis and treatment decision-making. Experiences described as positive largely focused on the attentiveness of the provider, the provider’s clear communication, and supplemental resources shared by the provider.

Attentiveness of the provider included descriptions about the time and attention spent with the patient and providing space for the patient to ask questions and be involved in their own care. Patients spoke about how that support was key to their knowledge about what to expect during cancer treatment. Patients recounted positive stories that demonstrated clear communication between the provider and the patient about their cancer diagnosis and treatment options. For instance, patients described the clear conversation and empathy that providers exhibited during their cancer diagnosis discussion and how it helped to process and make sense of everything. Similarly, other patients described how the information received from providers not only helped with understanding cancer treatment options but also possible side effects and secondary consequences.

Lastly, patients described how receiving supplemental written resources or books from their providers helped with their understanding of their cancer and cancer treatment, and in some cases, helped to ease their feelings and nerves about their diagnosis and treatment. Additionally, patients noted how the supplemental resources they received from their providers helped to facilitate their overall trust and confidence in their cancer care and treatment.

Negative Patient-Provider Relationships.

Some patients recounted stories of interactions and experiences with their providers that were negative and contributed to poor patient-provider relationships during their diagnosis and treatment decision-making. These experiences focused on the inattentiveness of the provider, the insufficient information shared by the provider, and the tone of the provider during conversations.

Stories that described provider inattentiveness largely focused on the provider not spending much time with the patient or not answering patients’ questions about their cancer or cancer treatment. For instance, some patients shared that their providers only focused on specific treatments rather than sharing information about all treatment options, and that no explanations were provided to them as to why specific treatments were chosen. Patients also described the short time they had with their providers and that specific information about their treatment was not provided to them unless they asked.

Patients who described negative patient-provider relationships also recounted the insufficient information and details shared with them about their cancer diagnosis and treatment. Some patients suggested that they were not advised properly about their treatment options. Other patients noted that they were left with unanswered questions and unresolved feelings, particularly around why the cancer occurred and whether it would recur.

Lastly, patients who described negative patient-provider relationships largely commented on the provider having a crude or blunt tone in the delivery of their cancer diagnosis or in conversations about their treatment decision-making which facilitated overall feelings of discomfort and mistrust. For instance, one patient described the initial conversation he had with his provider when he found out that he had cancer. He found it too blunt and direct, and without reassurance that he would be ok, leading this patient to find another treating provider because of the discomfort he felt. Other patients described feeling uneasy with the direct way in which providers used the word “cancer”. Additionally, patients noted that the medical terms used by providers to describe treatment options did not translate well with their understanding.

Decision-Making for Prostate Cancer Treatment.

Having a positive or negative patient-provider relationship shaped the type of conversations and decision-making processes for patients’ cancer treatment. There were three distinct decision-making processes that patients described; shared decision-making, trust-based deference to the doctor’s treatment recommendations due to expertise and trust, and authority-based deference to the doctor’s “orders” due to doctor’s authority.

Patients who discussed positive patient-provider relationships recounted stories of a shared decision-making process with their providers. Patients noted that their provider explained various treatment options including the pros and cons of treatment, made their recommendations, but ultimately left the decision up to the patient. Specifically, patients described their trust in their doctor’s knowledge and the importance that this shared decision-making process was for them so that they could be knowledgeable and prepared for what to expect during and after treatment. Patients who discussed positive patient-provider relationships also discussed how these relationships facilitated trust-based deference to the doctor’s treatment recommendations grounded in the doctor’s expertise and their confidence in their provider’s knowledge about cancer.

On the other hand, patients who described negative patient-provider relationships recounted stories about authority-based deference, following their doctor’s “orders” solely because of the doctor’s authority. In this, patients discussed that they needed to listen to their doctor solely because of their title. For instance, patients described their doctors not providing various treatment options to them and just telling them what they needed to do without participation or shared decision-making with the patient.

DISCUSSION

This study explored patient-provider communication and treatment decision-making for Latino patients with prostate cancer in Los Angeles, seen either at a private practice or at a safety net hospital. The findings of our study offer valuable insights into the experiences of Latino prostate cancer patients and underscore the role that patient-provider interactions play in shaping the decision-making process for prostate cancer treatment. The examination of positive and negative experiences within patient-provider relationships provided insight into the importance of effective communication, cultural competence, and shared treatment decision-making in fostering trust and satisfaction among Latino men with prostate cancer.

Participants who recounted positive interactions with their providers highlighted the attentiveness, clear communication, and supportive resources they received from their provider. These experiences collectively contributed to an enhanced understanding of their diagnosis and treatment options, which in turn reduced their anxiety and built trust in their provider and care. The provider’s attentiveness helped patients to feel involved and empowered in their care while the clear communication from providers allowed patients to process their diagnosis and navigate their treatment more effectively. In some instances provider communication extended beyond the patient to include family members present during clinical encounters, reflecting the cultural value of ‘familismo’ and the role that family plays in supporting Latino men through their cancer diagnosis and treatment [15,16]. While family involvement did not emerge as an independent theme in our analysis, these accounts suggest that providers who engaged family members as part of the communication process may have further reinforced patients’ sense of support and trust in their care. Further, the supplemental resources provided to patients contributed to their understanding, facilitating additional trust and confidence in their provider. Importantly, this information and engagement with providers helped to counter beliefs of fatalism, a cultural belief that cancer is determined by fate and out of one’s hands [15–17], as patients described their faith in their doctors to treat them. These positive interactions exemplify how patient-centered care, grounded in attentiveness and clear communication, supports a more collaborative and trust-based relationship for Latino men with prostate cancer.

Conversely, participants who recounted negative patient-provider interactions revealed barriers to effective communication and trust which hindered the patients’ decision-making processes and satisfaction with care. Patients described providers who appeared inattentive, spent minimal time with them, and failed to answer their questions, which left patients feeling uninformed about their treatment options. This lack of engagement was compounded by insufficient information regarding their diagnosis and reasons behind the recommended treatment, resulting in patients experiencing feelings of confusion, unresolved questions, and a limited sense of autonomy. Further, patients cited issues with providers’ tone, describing interactions where the discussion about their cancer diagnosis felt blunt or crude, contributing to overall feelings of discomfort and mistrust. Previous work has found that Latino men immediately associate a cancer diagnosis with death [17,18], making patient-provider interactions especially critical as the provider’s tone that our participants described may have strained the relationship and deepened feelings of death and dying during conversations. Additionally, provider’s lack of ‘simpatía,’ a cultural expectation of warmth, kindness, and respect in interpersonal interactions [15,16], may have further intensified feelings of mistrust toward their providers. It is also important to consider the role of language in shaping the patient-provider communication experiences described by our participants. The majority of men in our study were monolingual Spanish speakers receiving care in a predominately English-speaking health system, and language barriers may have compounded the communication challenges they described, including feelings of being uninformed, receiving insufficient explanations, and encountering provider tones that felt blunt or dismissive. Language-concordant care has been documented as a key driver of communication quality, trust, and shared decision-making for Latino patients [19,20], and the potential absence of language-concordant providers or trained interpreter services may have contributed to the negative patient-provider experiences reported. These dynamics underscore the importance of linguistic accessibility as a foundational component of culturally responsive cancer care for Latino men. These negative interactions illustrate how a lack of cultural sensitivity, insufficient information-sharing, and unempathetic communication can erode trust and limit patients’ engagement and knowledge about their cancer care.

Together, our findings emphasize the need for patient-centered prostate cancer care that works to enhance patient knowledge about their cancer diagnosis and treatment decision-making while building positive patient-provider relationships and communication. One previous qualitative study highlighted that urologists see themselves as playing an important role in educating patients about their treatment options and should do so using tailored conversations and approaches that are concordant with patients’ knowledge, values, concerns, and goals [21]. However even with this sentiment, low levels of communication between patients and providers surrounding prostate cancer screening and treatment has been reported [22]. Moreover, unmet supportive care needs were associated with lower patient-provider communication among Hispanic/Latino prostate, colorectal, and breast cancer survivors [23]. Additionally, greater satisfaction with provider communication was reported to be associated with better health status and outcomes among cancer survivors [11]. Importantly, one population-based study found that Hispanic/Latina cancer survivors reported worse patient-provider communication compared to their white counterparts [24]. Our findings add strength to a growing literature that highlights the need to improve patient-provider communication to be patient-centered and culturally tailored in order to improve patient knowledge, treatment experiences, and long-term health outcomes, contributing novel data for Latino prostate cancer patients. Future research should identify barriers to positive patient-provider relationships and determinants of poor patient-provider communication for Latino men with prostate cancer, to guide future interventions, as there are implications for short and long-term health knowledge, health efficacy, and health outcomes.

In our study, we also found that the nature of the patient-provider relationship significantly influenced patients’ decision-making processes for prostate cancer treatment. In positive experiences of patient-provider communication, shared decision-making was a prominent theme where providers offered information on various treatment options, discussed pros and cons, offered recommendations, but ultimately left the decision to the patient. This approach allowed patients to feel involved and respected in their treatment journey, fostering trust in their provider’s knowledge and expertise. Past studies have echoed the support in shared decision-making strategies for patients with localized prostate cancer as those that were actively involved in treatment decision making experienced less decision conflict and less decision regret compared to patients who experienced more passive involvement in their care [13]. Additionally, shared decision-making in prostate cancer treatment has been reported to have moderate effects on knowledge, perception of being informed, and quality of life [12]. Even among patients who described positive patient-provider communication, many exhibited trust-based deference to their providers, following their provider’s treatment recommendations based on confidence in their provider’s expertise and knowledge about cancer. This pattern is consistent with previous work demonstrating that Latino men often defer to their health providers’ recommendations, reflecting the Latino cultural value of ‘respeto’, or respect for authority figures due to their position in society [16,18]. Our findings are in line with previous work that examined shared decision-making in Latino men with prostate cancer and characterized relationships between Latino men and their providers as “paternalistic”, emphasizing reliance on physician expertise and treatment recommendations [14]. However, our study extends this prior work by revealing the upstream communication dynamics that shape how Latino men engage with and respond to their providers. Specifically, we find that deference to physician authority is not a uniform phenomenon but takes two distinct forms depending on the quality of the patient-provider relationship: trust-based deference, rooted in positive communication experiences and confidence in their provider, and authority-based deference, driven by compliance with physician directives in the absence of meaningful engagement or shared decision-making. Patients who experienced attentive, clear, and culturally responsive communication were more likely to describe shared-decision making or trust-based deference while those who experienced inattentive or blunt communication described authority-based deference following doctor’s orders without understanding their options or feeling heard. Together these findings may highlight that for Latino men, trust in their provider and clear communication about their treatment plans may be more salient than the process of shared decision-making. Future research should work to disentangle the aspects of patient-provider communication that are most important for Latino men to evaluate and optimize the decision-making processes that surround prostate cancer treatment.

It is also worth noting that our sample was recruited across two clinically distinct settings, an NCI-designated academic cancer center and a large urban safety-net hospital, that differ meaningfully in resources, insurance status, and access to specialty care, despite being served by many of the same physicians. While site-level comparisons were not a focus of the current study, aggregating across these settings may obscure differences in patient-provider communication experiences that are tired to healthcare system contexts. Patients receiving care at safety-net institutions, for instance, may face structurally distinct communication barriers related to provider time constraints, interpreter availability, and continuity of care [25,26]. Importantly, however, the communication dynamics we identified, including both positive and negative patient-provider experiences and their influence on treatment decision-making, were observed across both clinical settings, suggesting these patterns may reflect broader structural and cultural dimensions of care for Latino men with prostate cancer rather than being specific to any one health system context. Future research should explicitly examine how health system settings shapes patient-provider communication experiences among Latino men with prostate cancer.

Our findings have direct implications for clinical practice and health systems serving Latino men with prostate cancer. At the clinical level, findings point to the need for provider training in culturally responsive communication that centers cultural values such as ‘familismo’ and ‘simpatía’ in conversations related to diagnosis and treatment, with particular attention to the moment of cancer diagnosis itself, where provider tone and attentiveness appeared especially consequential for shaping patient’s trust and engagement in care.[27] Interventions designed to improve shared-decision making including the distribution of printed education materials, use of accessible language, and implementation of decision aid tools have been linked to improvements in patient knowledge and trust, adherence to treatment recommendations, reduction in decision regret, and improved health outcomes.[28–31] Health systems should also consider standardizing the provision of written materials in patients’ preferred language and ensuring access to trained medical interpreters, particularly for Spanish-dominant patients navigating complex treatment decision.[32] Community health worker and patient navigation models, which have demonstrated effectiveness in Latino cancer populations,[30,33] may be especially well-suited to reinforce provider communication, support patients in formulating questions, and bridge gaps in understanding between patients and their care teams. Efforts to increase the diversity of the oncology and urology workforce, including the recruitment and retention of Spanish-speaking and Latino providers and staff, may further reduce communication barriers and foster the culturally grounded trust that our participants described as central to their care experiences.[34] At the policy level, extending appointment time for newly diagnosed cancer patients, mandating interpreter services in oncology settings, and requiring the integration of shared decision-making practices into standard oncology care are concrete steps that could address the communication barriers and limited patient engagement our participants described. While implementation of these strategies may face barriers such as limited institutional resources, time constraints in clinical settings, and workforce shortages, partnerships with community-based organizations and federally qualified health centers may help to expand reach and sustainability.[35–37]

Among the strengths of our study is the focus on Latino men, an understudied population, recruited across two different clinics that capture a heterogeneous sample of Latino patients, thus contributing to the generalizability of our findings. Despite this, given the heterogeneity of the Latino population in the US, our findings should be interpreted with caution in relation to other Latino subgroups and settings. Our sample was predominately Mexican-origin and immigrant men recruited from two urologic clinics in Los Angeles County, and experiences may differ among US-born Latino men, those of Caribbean or Central and South American origin, or those receiving care in other geographic regions or health systems contexts such as rural settings, community health centers, or states with smaller Latino populations. Additionally, while we interviewed Latino men in either English or Spanish based on patient’s preference, we did not explicitly explore subgroup differences in patient-provider communication by language or utilization of translation services. Further, explicit subgroup analyses by other demographic and treatment characteristics such as nativity, age, and recruitment site were not conducted. Though no observable patterns distinguished by these characteristics emerged during our analytic process, such differences may be meaningful, and future research should explicitly examine how these factors shape patient-provider communication, relationships, and decision-making processes among Latino men with prostate cancer. Finally, as with all qualitative research relying on self-report, participants’ accounts of their patient-provider interactions may be subject to recall bias, social desirability, or retrospective reinterpretation of their experiences. To minimize interviewer influence, we employed a semi-structured guide that allowed participants to direct the narrative, and interviews were conducted in participants’ preferred language to reduce linguistic barriers to authentic expression. Nevertheless, the presence of an interviewer and the institutional affiliation of the research team may have shaped participant responses in ways that are difficult to fully account for. Additionally, participants received a gift card upon completion of their interview or focus group, and it is possible that this incentive may have influenced the nature of participant responses, including social desirability effects. Further, data collection spanned May 2020 to October 2022, a period during which the COVID-19 pandemic substantially altered clinical care delivery, including a shift toward telehealth and telephone-based encounters. It is possible that pandemic-era changes in clinical encounter format influenced the patient-provider interactions participants were recalling and that experiences described may not fully reflect typical in-person dynamics. We did not account for whether participants’ interactions with their providers occurred in person or via telehealth, which may have shaped communication experiences in ways we did not assess. Although our findings are specific to Latino men with prostate cancer in Los Angeles, the communication dynamics we identified, including the influence of provider tone, attentiveness, and cultural responsiveness on trust and decision-making, may have relevance for other racial and ethnic minority populations navigating cancer care, and future research should examine whether similar patterns emerge in other racial/ethnic groups, cancer types, and health care settings.

CONCLUSION

Our qualitative study explored patient-provider communication and treatment decision-making for Latino patients with prostate cancer within two distinct urologic clinics in Los Angeles. We found that patient-provider relationships and communication, in particular positive and negative experiences, largely impacted the decision-making processes for prostate cancer treatment. Our findings underscore the importance of patient-provider relationships to facilitate positive care experiences and shared decision-making processes among Latino prostate cancer patients. Future research should explore specific determinants of positive patient-provider relationships and communication to guide strategies to facilitate positive cancer care and treatment experiences for Latino men.