Shared decision making, physicians' explanations, and treatment satisfaction: a cross-sectional survey of prostate cancer patients

Abstract

Background: Hormone therapy is one option for some types of prostate cancer. Shared decision making (SDM) is important in the decision making process, but SDM between prostate cancer patients receiving hormone therapy and physicians is not fully understood. This study tested hypotheses: "Patients' perception of SDM is associated with treatment satisfaction, mediated by satisfaction with physicians' explanations and perceived effective decision making" and "The amount of information provided to patients by physicians on diseases and treatment is associated with treatment satisfaction mediated by patients' perceived SDM and satisfaction with physicians' explanations."

Methods: This cross-sectional study was conducted using an online panel via a private research company in Japan. The participants in this study were patients registered with the panel who had received or were currently receiving hormone therapy for prostate cancer and physicians registered with the panel who were treating patients with prostate cancer. Measures used in this study included a nine-item Shared Decision Making Questionnaire, levels of satisfaction with physicians' explanations and treatment satisfaction, and effective decision making for patients (feeling the choice is informed, value-based, likely to be implemented and expressing satisfaction with the choice), and a Shared Decision Making Questionnaire for Doctors. The hypotheses were examined using path analysis.

Results: In total, 124 patients and 150 physicians were included in the analyses. In keeping with our hypotheses, perceived SDM significantly correlated with the physicians' explanations and perceived effective decision making for patients, and satisfaction with physicians' explanations and perceived effective decision making for patients were both related to treatment satisfaction. Although the amount of information provided to patients was correlated with the perceived SDM, it was indirectly related to their satisfaction with physicians' explanations.

Conclusions: When physicians encourage patients to be actively involved in making decisions about treatment through the SDM process while presenting a wide range of information at the start of hormone therapy, patients' effective decision making and physicians' explanations may be improved; consequently, the patients' overall treatment satisfaction may be improved. Physicians who treat patients with prostate cancer may have underestimated the importance of SDM before starting hormone therapy, even greater extent than patients.

Keywords: Effective decision making; Hormonal therapy; Information provision; Patients and healthcare providers communication; Prostate cancer; SDM-Q-9; SDM-Q-Doc; Shared decision making; Survey; Treatment satisfaction.

Fig. 1

Conceptual framework for path analyses. Path diagram was developed to evaluate a relationship between perceived shared decision making, physicians’ explanations, and treatment satisfaction in patients with prostate cancer receiving hormone therapy. Squares represent measured variables

Fig. 2

Path diagram for the patient group. Significant path coefficient was obtained for all cases. Squares represent measured variables, and values are path coefficients. e1 – e4 represent errors. *p < 0.05, **p < 0.01, ***p < 0.001

Fig. 3

Path diagram for the physician group. Significant path coefficient was obtained for all cases except a path from perceived effective decision making to treatment satisfaction (path coefficient 0.07, P = 0.15). Squares represent measured variables, and values are path coefficients. e1 – e4 represent errors. **p < 0.01, ***p < 0.001