Association of Actual and Preferred Decision Roles With Patient-Reported Quality of Care

Abstract

Importance Shared decision-making is associated with improved patient-reported outcomes, but not all patients prefer to participate in medical decisions. Studies of the effect of matching between actual and preferred medical decision roles on cancer patients’ perceptions of care quality have been conflicting. Objective To determine whether shared decision-making was associated with patient ratings of care quality and physician communication, and whether patients’ preferred decision roles modified those associations. Design We surveyed lung and colorectal cancer patients, diagnosed from 2003–2005, participating in the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study. We asked patients about their preferred roles in medical decisions and actual roles in decisions about surgery, chemotherapy, and radiation. We assessed associations of patients’ decision roles with patient-reported quality of care and physician communication. Setting A population- and health-system-based cohort of lung and colorectal cancer patients, treated in integrated care delivery systems, academic institutions, private offices, and Veterans Affairs hospitals. Participants The CanCORS study included 9737 patients (cooperation rate among patients contacted, 59.9%). We analyzed 5315 patients (56% with colorectal, 40% with non-small cell lung, and 5% with small cell lung cancer) who completed baseline surveys and reported decision roles for a total of 10817 treatment decisions. Main Outcome Measures The outcomes (identified before data collection) included patient-reported “excellent” quality of care and top ratings (highest score) of physician communication scale. Results After adjustment, patients describing physician-controlled (versus shared) decisions were less likely to report excellent quality of care (odds ratio, OR=0.64, 95%CI=0.54–0.75; P<0.001); patients’ preferred decision roles did not modify this effect (P for interaction=0.29). Both actual and preferred physician-controlled (versus shared) roles were associated with lower ratings of physician communication (OR=0.55, 95%CI 0.45–0.66, P<0.001, and 0.67, 95%CI 0.51–0.87, P=0.002 respectively); preferred role did not modify the effect of actual role (P for interaction=0.76). Conclusions and Relevance Physician-controlled decisions regarding lung or colorectal cancer treatment were associated with lower ratings of care quality and physician communication. These effects were independent of patients’ preferred decision roles, underscoring the importance of seeking to involve all patients in decision-making about their treatment.

Associations Between Patient Perceptions of Communication, Cure, and Other Patient-Related Factors Regarding Patient-Reported Quality of Care Following Surgical Resection of Lung and Colorectal Cancer

“…All patients including patients with metastatic disease (stage IV) were included in this study as previous studies have shown that patients with advanced disease often have unrealistic perceptions of cure. 14 Patient-reported assessment of quality of care, role in decision-making, patient – physician communication, and perceptions about potential beneficial and adverse effects of surgical treatment were derived from CanCORS survey questions and categorized as previously described (Supplementary Table S1) 4,6,15 . Assessment of physician communication skills was calculated from five survey items that were derived from the Consumer Assessment of Healthcare Providers and Systems (CAHPS), with an indication 0 as the worst possible communication and 100 as optimal communication.…”

“…Previous studies have also shown that though these cancers are different from a clinical standpoint, there are similarities regarding patient perceptions of care and quality among these groups. 6–8 Thus, we hypothesized that poor patient–physician communication would be associated with worse patient-reported quality of care. 6,9 Furthermore, we sought to identify sociodemographic, clinical, and decision-making/communication factors that were associated with excellent patient-reported quality of overall and surgical care among patients with lung and colorectal cancer undergoing surgery.…”

Primary Breast Cancer Decision-making Among Chinese American Women

“…Most of the research has been conducted on preferences in the decision-making process (Degner et al, 1997;Lantz et al, 2005), but few studies have addressed the influences of sociodemographic characteristics on decision outcomes (O'Connor, 2006), and those have primarily been in the context of preferred and actual involvement in the decision-with an increasing emphasis on perceived quality of cancer care as a critical outcome (Hawley et al, 2007;Kehl et al, 2015). There is no known research on the factors that contribute to decisional outcomes for Asian American or Chinese American women diagnosed with breast cancer.…”

Why Young Patients with Cancer Require Different Coping Tools?

“…There have been many advances that reduce mortality [6], and the negative consequences of the disease. Nevertheless, it is essential to deepen and extend the psychological and social assistance to these patients, even once discharged.…”