Cancer Patients Prefer Care That Includes Their Input

Cancer Patients Prefer Care That Includes Their Input

Cancer Patients Prefer Care That Includes Their Input

But whether shared decision making results in better outcomes isn't clear, study finds

SOURCES: Kenneth Kehl, M.D., oncology fellow, University of Texas MD Anderson Cancer Center, Houston; Reshma Jagsi, M.D., D.Phil., associate professor, radiation oncology, University of Michigan, Ann Arbor; Feb. 12, 2015, JAMA Oncology, online

THURSDAY, Feb. 12, 2015 (HealthDay News) -- Cancer patients who let their doctors make all the decisions are less likely to rate their care as excellent compared to patients who participate in their medical decisions, a new study suggests.

"We found that patients with lung or colorectal cancer who felt more involved in decision making about their treatments had higher perceptions of the quality of the care they received and of communication with their physicians," said study author Dr. Kenneth Kehl, an oncology fellow at the University of Texas MD Anderson Cancer Center in Houston.

The Institute of Medicine has urged doctors to share decision making and take patient preferences into account as a way to improve the overall quality of care, the researchers noted.

But whether shared decisions actually improve medical care is something this study cannot answer, Kehl said.

"If, for example, we had assessed whether shared decision making was associated with guideline-recommended surgical treatment for cancer, we might have found that patients with shared decisions were more likely to have surgery. One explanation could be that shared decision making actually led to higher rates of surgery," Kehl explained.

However, when physicians tell patients they are too ill or their cancer is too advanced to have surgery, patients do not perceive those decisions as shared, Kehl added.

"For that reason, we assessed care quality for a treatment only when patients actually received a treatment," he said.

Kehl's group concluded that even among patients who have preferences for physician-controlled medical decisions, shared decision making may improve their satisfaction with care.

The report was published online Feb. 12 in the journal JAMA Oncology.

Dr. Reshma Jagsi is an associate professor of radiation oncology at the University of Michigan in Ann Arbor, and co-author of an editorial that accompanied the study. "These results are in contrast to prior work that suggested that it is the match between patients' preferred and actual involvement that contributes to greater satisfaction with care," she said.

"These conflicting results underscore the need for further work to better quantify and link measures of shared decision making to patient appraisal of care," she added.

For the study, Kehl and colleagues collected data on more than 5,300 patients with lung cancer or colon cancer who took part in the Cancer Care Outcomes Research and Surveillance Consortium study.

These patients reported their role in almost 11,000 treatment decisions, along with their perception of the quality of their care and how well they communicated with their doctors.

Most patients, 58 percent, said they preferred shared roles in decision making, and 36 percent preferred patient-controlled decisions. Only 6 percent said they wanted their doctor to make all the decisions.

Of the decisions made by patients, 42 percent were about surgery, 36 percent regarded chemotherapy and 22 percent were about radiation therapy, the researchers found.

Researchers found that patients made 39 percent of actual decisions, and 44 percent were shared. However, 17 percent of decisions were made by doctors alone.

In all, 67.8 percent of the patients said their care was excellent. Although patient preference for shared decision making was not a factor in how they rated their care, those who let doctors make all the decisions were less likely to rate their care as excellent, the researchers found.

In addition, 55.8 percent of patients gave their doctors the highest rating for doctor/patient communication. However, patients who preferred physician-controlled decision making were less likely to give their doctor a high rating, as were patients who experienced physician-controlled versus shared decisions, the researchers found.

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