Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration

Abstract

Patient participation in treatment decision-making is being increasingly advocated, although cancer treatments are often guideline-driven. Trade-offs between benefits and side effects underlying guidelines are made by clinicians. Evidence suggests that clinicians are inaccurate at predicting patient values. The aim was to assess what role oncologists and cancer patients prefer in deciding about treatment, and how they view patient participation in treatment decision-making. Seventy disease-free cancer patients and 60 oncologists (surgical, radiation, and medical) were interviewed about their role preferences using the Control Preferences Scale (CPS) and about their views on patient participation using closed- and open-ended questions. Almost all participants preferred treatment decisions to be the outcome of a shared process. Clinicians viewed participation more often as reaching an agreement, whereas 23% of patients defined participation exclusively as being informed. Of the participants, > or = 81% thought not all patients are able to participate and > or = 74% thought clinicians are not always able to weigh the pros and cons of treatment for patients, especially not quality as compared with length of life. Clinicians seemed reluctant to share probability information on the likely impact of adjuvant treatment. Clinicians should acknowledge the legitimacy of patients' values in treatment decisions. Guidelines should recommend elicitation of patient values at specific decision points.

Figure 1

Patients' (N=70) and clinicians' (N=60) control preferences in deciding about preoperative radiotherapy (PRT). Note: Phrasing of control preferences roles in patient interviews: (A) I prefer to make the decision about my treatment; (B) I prefer to make the decision about my treatment, after seriously considering my doctors' opinion; (C) I prefer that my doctor and I make the decision about my treatment jointly; (D) I prefer that my doctor makes the decision about my treatment, after seriously considering my opinion; (E) I prefer to leave the decision about my treatment to my doctor. Phrasing of control preferences roles in clinician interviews: (A) I prefer to leave the decision about treatment to my patient; (B) I prefer that my patient makes the decision about treatment, after seriously considering my opinion; (C) I prefer that my patient and I make the decision about treatment jointly; (D) I prefer to make the decision about treatment, after seriously considering my patient's opinion; (E) I prefer to make the decision about treatment.