UNC Urologist Dr. Hung-Jui (“Ray”) Tan recently joined host Dr. Ruchika Talwar on the BackTable Urology Podcast to unpack a central but often overlooked challenge in genitourinary cancer care: how patient fear and uncertainty can shape risk perception and treatment preferences and how communication can impact how patients take in and act upon clinical evidence.
In the episode, titled “Shared Decision Making in GU Cancer Management,” Dr. Tan outlines emerging evidence on decisional conflict – a measurable form of uncertainty that predicts patient satisfaction, regret, and downstream health outcomes. His research demonstrates that even in clinically low-risk conditions, such as small renal masses or low-risk prostate cancer, patients frequently perceive their situation as high-stakes and urgent, often arriving with significant anxiety and a strong presumption that surgery is necessary.
Evidence, Emotion, and the “Temperature” of the Room
Drawing from his team’s ongoing research, Dr. Tan emphasizes the importance of “turning down the temperature” before introducing data or options. Many patients feel they have a significant risk of metastasis from a small renal mass despite robust data showing that true metastatic risk is extremely low in most cases. Clinicians may be prepared to talk about surveillance, but patients may not yet be emotionally ready to hear it.
“Acknowledging a patient’s fear—before sharing data—can change the trajectory of the visit,” Tan notes, pointing out that empathy and reassurance create space for informed, collaborative decision-making.
Decision Aids, Visualization, and Communication Strategies
Dr. Tan discusses several practical strategies to support patients facing complex choices:
- Showing imaging of the tumor, which helps patients visually contextualize its size and seriousness.
- Using simple, evidence-based messaging that integrates empathy, not just probabilities.
- Leveraging structured communication frameworks such as Best Case/Worst Case or Better Conversations.
- Considering short-interval “trial periods” of surveillance, which reduce pressure to decide immediately.
These approaches facilitate shared decision making without sacrificing clinical rigor, while helping patients avoid feeling rushed toward an irreversible choice.
AI, Technology, and the Next Phase of Decision Science
The episode also explores how AI and digital tools may change risk communication and health information-seeking behaviors. While patients increasingly consult tools like ChatGPT, Dr. Tan notes that trust, empathy, and human connection continue to shape patient decisions more than any technological interface.
His team is actively testing personalized messaging frameworks that deliver tailored education prior to clinical visits, with the goal of reducing patient anxiety, improving preparedness, and enhancing shared decision making.
A Call to Action for Clinicians
Dr. Tan emphasizes that shared decision making is not just a soft skill—it is a clinical competency with measurable impact on outcomes, adherence, and resource utilization. Urologists, he says, are uniquely positioned to lead in this domain.
“What we say has an outsized influence on what patients feel and ultimately decide. With that comes a lot of responsibility—and opportunity.”
About Dr. Tan and His Research Program
Dr. Hung-Jui “Ray” Tan serves as Division Chief of Urologic Oncology at the UNC Department of Urology. His research program focuses on decision science, risk communication, and cancer survivorship, with ongoing studies examining:
- Drivers of decisional conflict
- The role of renal mass biopsy in decision-making experience
- Patient-centered communication strategies
- Frameworks for guiding treatment vs. surveillance conversations
This work reflects UNC Urology’s broader commitment to patient-centered, evidence-based care and to advancing national leadership in academic urology.