Concordance between patients' desired and actual decision‐making roles in breast cancer care

Abstract

This study explored breast cancer patients' preferences and experiences for participation in treatment decision making as well as the concordance between patients' actual and desired decision making. The interplay between depression, anxiety and decision-making preferences was also examined.A consecutive sample of primary breast cancer patients was recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy in two breast cancer centres in Germany. Women were asked to complete a self-explanatory questionnaire. Most patients (40.2%) of the 137 participants preferred the physician to make the treatment decision. A total of 63.4% were able to fulfil their preferred decision-making role. Breast cancer patients who wanted the physician to make the decision and patients who wanted to make the decision on their own were more likely to have their preferences met than patients who wished to share the decision (p < 0.01). Availability of treatment choice and the level of depression influenced the preferred decision-making preference. Limited concordance between desired and actual decision making of patients with collaborative decision-making preferences suggests the need for better communication and physician training on shared decision making.

Use of opioid analgesics or sleeping medication and survival of cancer patients

“…This discrepancy is perhaps because the association between survival rate and hospital size/level might be specific to certain types of tumors, such as oesophagus carcinomas, hepatic carcinomas, lung carcinomas, ovary carcinomas, prostate carcinomas, and lymphomas (Ioka et al, 2007). Some researchers have also suggested that differences in physician characteristics may affect treatment decisions (Vogel et al, 2008); however, our study did not confirm that finding.…”

Arthritis patients’ motives for (not) wanting to be involved in medical decision-making and the factors that hinder or promote patient involvement

“…Patients' preferences regarding involvement in MDM have been explored in some depth for irreversible decisions like screening or surgery [15,[18][19][20][27][28][29] but are less well known for decisions concerning chronic health problems, such as arthritis, where the doctor-patient relationship is potentially a long-term one [30]. In managing arthritis, the decision-making process has become increasingly complex due to the rapid development of n e w d i s e a s e m o d i f y i n g a n t i -r h e u m a t i c d r u g s (DMARDs).…”

Shared decision-making in rheumatology : what matters to patients?

“…However, the amount of concordance varied significantly between decisions; a considerable group (on average 34%) still wanted more participation than they perceived. These results are comparable to studies examining other conditions, such as cancer and asthma where concordance levels varying from 34% -66% have been reported (36,75,79,80,100,114).…”