A cross‐sectional study of patient and provider perception of “cure” as a goal of cancer surgery

Winner, Megan; Wilson, Ana; Yahanda, Alexander T.; Kim, Yuhree; Pawlik, Timothy M.

doi:10.1002/jso.24401

Cited by 13 publications

(21 citation statements)

References 51 publications

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“…All 32 included publications had a cross‐sectional study design, 11 of which derived their patient population from previous cohort studies, or from the control group of a randomized trial. Twenty of the 32 studies were published after 2010, 11 between 2000 and 2010, and one in 1989.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of shared decision-making in surgery

Mik

Stubenrouch

Balm

et al. 2018

British Journal of Surgery

122

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BackgroundMultiple treatment options are generally available for most diseases. Shared decision‐making (SDM) helps patients and physicians choose the treatment option that best fits a patient's preferences. This review aimed to assess the extent to which SDM is applied during surgical consultations, and the metrics used to measure SDM and SDM‐related outcomes.MethodsThis was a systematic review of observational studies and clinical trials that measured SDM during consultations in which surgery was a treatment option. Embase, MEDLINE and CENTRAL were searched. Study selection, quality assessment and data extraction were conducted by two investigators independently.ResultsThirty‐two articles were included. SDM was measured using nine different metrics. Thirty‐six per cent of 13 176 patients and surgeons perceived their consultation as SDM, as opposed to patient‐ or surgeon‐driven. Surgeons more often perceived the decision‐making process as SDM than patients (43·6 versus 29·3 per cent respectively). SDM levels scored objectively using the OPTION and Decision Analysis System for Oncology instruments ranged from 7 to 39 per cent. Subjective SDM levels as perceived by surgeons and patients ranged from 54 to 93 per cent. Patients experienced a higher level of SDM during consultations than surgeons (93 versus 84 per cent). Twenty‐five different SDM‐related outcomes were reported.ConclusionAt present, SDM in surgery is still in its infancy, although surgeons and patients both think of it favourably. Future studies should evaluate the effect of new interventions to improve SDM during surgical consultations, and its assessment using available standardized and validated metrics.

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Section: Resultsmentioning

confidence: 99%

“…Two studies compared SDM among patients and among surgeons using the CPS questionnaire. Eighty‐nine of 204 surgeons (43·6 per cent) perceived the decision‐making process as SDM.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of shared decision-making in surgery

Mik

Stubenrouch

Balm

et al. 2018

British Journal of Surgery

122

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“…By reporting data both on individual specific metrics, as well as composite TOO, patients are better equipped to frame expectations around their short‐ and long‐term care. Data from our own group have demonstrated that patients tend to be overly optimistic relative to expectations around both short‐ and long‐term outcomes compared with their surgeons 19,20 . Specifically, compared with surgeons, patients tend to underestimate the risk of perioperative complications, while overestimating the potential therapeutic benefit of surgery 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Data from our own group have demonstrated that patients tend to be overly optimistic relative to expectations around both short‐ and long‐term outcomes compared with their surgeons 19,20 . Specifically, compared with surgeons, patients tend to underestimate the risk of perioperative complications, while overestimating the potential therapeutic benefit of surgery 20 . Providing patients data on composite measures such as textbook outcome and TOO may facilitate more “realistic” conversations and help frame expectations around complex surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma

Sweigert

Eguia

Baker

et al. 2020

Journal of Surgical Oncology

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Background Composite outcomes may more accurately reflect patient and provider expectations around optimal care. We sought to determine the impact of achieving a so‐called “textbook oncologic outcome” (TOO) among patients undergoing resection of pancreatic adenocarcinoma (PDAC). Methods Patients undergoing pancreaticoduodenectomy (PD) for PDAC between 2006 and 2016 were identified in the National Cancer Database (NCDB). TOO was defined by: margin negative resection, compliant lymph node evaluation, no prolonged length‐of‐stay, no 30‐day readmission/mortality, and receipt of adjuvant chemotherapy. Factors associated with TOO and overall survival (OS) were evaluated using multivariable logistic and Cox regression models, respectively. Results Among 18 608 patients who underwent PD at 782 hospitals, many patients successfully achieved certain TOO factors such as R0 margin (77.9%) and no 30‐day mortality (96.9%), while other TOO criteria such as receipt of adjuvant therapy (48.2%) were achieved less frequently. Overall, only 3124 (16.8%) patients achieved a TOO. Factors associated with lower odds of TOO included: older age, Black race, Medicaid insurance, Community facility, and low PD facility (<20 PD/y) (all P < .05). Achievement of a TOO was associated with lower risk of mortality (HR 0.74; 95% CI, 0.70‐0.77). Conclusions While TOO was associated with improved long‐term survival, TOO was only achieved in 16.8% of patients undergoing PD.

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“…However, perioperative data evaluating the effects of patient expectations on outcomes predominantly include benign surgical indications and are highly heterogeneous in origin and conclusions 10‐12 . Contemporary studies have qualitatively analyzed various aspects of surgeon‐patient communication, such as surgeon and patient buy‐in, 13 incorporation of quality of life considerations into discussions, 14 completeness of information relayed, 15 and surgeon‐led end‐of‐life discussions 4 . Communication and decision tools have been produced as a result 15‐19 .…”

Section: Introductionmentioning

confidence: 99%

Surgeon and patient perceptions of cure in advanced gastrointestinal malignancies: Are we on the same page?

Lafaro

Rodriguez

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Effective communication is essential to complex shared decision making and is associated with improved recovery and pain control. However, patients and surgeons often have disparate expectations of treatment efficacy and perceptions of cure for advanced malignancies. This study measures correlation of patient and surgeon expectations with perceptions of cure. Methods Our prospective study surveying surgeon‐patient dyads before and after surgical consultation was performed for advanced abdominal malignancy between July and November 2017 at a single NCI designated cancer center using electronic questionnaires. Results Patients and surgeons' own opinions regarding surgical candidacy (Q1), chance at cure (Q2), and life expectancy (Q3) did not measurably change from pre‐ to postvisit survey as evidenced by unchanged response concordance (patients Q1 P = .82; Q2 P = .81; and Q3 P = .53; surgeon responses Q1: P = .17; Q2: P = .32; and Q3: P = .50). Patient and surgeon perception of likelihood of cure and of estimated life expectancy remained discordant in pre‐ and postvisit surveys (Q2: P = .006 and Q3: P = .03). Conclusions These data highlight the stark differences between patient and surgeon perceptions of cure and prognosis of gastrointestinal cancers. These results prove that a larger scale study using this electronic questionnaire is feasible and important to better understand these differences and enhance shared decision making.

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A cross‐sectional study of patient and provider perception of “cure” as a goal of cancer surgery

Abstract: Patients with resectable lung and gastrointestinal cancers have more optimistic perceptions about the outcomes of an upcoming surgery than their surgeons, even in a setting of good communication and shared decision-making. J. Surg. Oncol. 2016;114:677-683. © 2016 Wiley Periodicals, Inc.

Cited by 13 publications

References 51 publications

Systematic review of shared decision-making in surgery

Systematic review of shared decision-making in surgery

Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma

Surgeon and patient perceptions of cure in advanced gastrointestinal malignancies: Are we on the same page?

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