Decisional Control Preferences, Disclosure of Information Preferences, and Satisfaction Among Hispanic Patients With Advanced Cancer

Abstract

Context Studies to determine the decisional control preferences (DCPs) in Hispanic patients receiving palliative care are limited. Objectives The aims of this study were to describe DCPs, disclosure of information, and satisfaction with decision making among Hispanics, and to determine the degree of concordance between patients’ DCPs and their self-reported decisions. Methods We surveyed 387 cancer patients referred to outpatient palliative care clinics in Argentina, Chile, Guatemala, and the U.S. DCPs were measured with the Control Preference Scale, disclosure preferences with the Disclosure of Information Preferences questionnaire, and satisfaction with care with the Satisfaction with Decision Scale. Results In this study, 182 patients (47.6%) preferred shared decisional control, 119 (31.2%) active decisional control, and 81 (21.2%) preferred a passive approach. Concerning diagnosis and prognosis, 345 (92%) patients wanted to know their diagnosis, and 355 (94%) wanted to know their prognosis. Three hundred thirty-seven (87%) patients were satisfied with the decision-making process. DCPs were concordant with the self-reported decision-making process in 264 (69%) patients (weighted kappa, 0.55). Patients’ greater satisfaction with the decision-making process was correlated with older age (P≤0.001) and with a preference for enhanced diagnostic disclosure (P≤0.024). Satisfaction did not correlate with concordance in the decision-making process. Conclusion The vast majority preferred a shared or active decision-making process and wanted information about their diagnosis and prognosis. Older patients and those who wanted to know their diagnosis seemed to be more satisfied with the way treatment decisions were made.

The Effect of Message Content and Clinical Outcome on Patients' Perception of Physician Compassion: A Randomized Controlled Trial

“…Finally, certain studies conducted in different patient populations suggest that patients preferred either a shared or an active decision‐making preference over a passive one . However, studies have found that patients who preferred a certain decision‐making strategy were satisfied with the way decisions were made in their care even when actual decision‐making may be different from their preferred role . Further studies investigating the preferred and perceived decision‐making role of patients and their influence in perception of different physician attributes would be worthwhile.…”

End-of-Life Care Matters: Palliative Cancer Care Results in Better Care and Lower Costs

“…Some studies showed an encouraging trend of a lower proportion of cancer patients dying in acute care hospitals and a higher number of hospice enrollments in the last month of life, but this was dampened by findings of higher rate of ICU and hospital utilization in the last months of life and higher proportion of hospice referrals in the last 3 days of life, respectively . The studies highlight the importance of eliciting individual preferences via better communication, as there is frequent disagreement whenever physicians assume what their patients would prefer . Among cancer patients, preferences for making such decisions vary, ranging from active to passive, with shared decision‐making being the most preferred .…”

“…The key to successful integration is to focus on collaboration and communication between oncologists and PC clinicians about roles and responsibilities between those clinicians with patients and families regarding the goals of care. Current data suggest communication gaps in eliciting individual preferences for communication . Recent preliminary studies suggest the usefulness of communication aids such as prompt sheets or cards .…”

Rapport between Cancer Patients and Their Physicians is Critical for Patient Satisfaction with Treatment Decisions

“…However, several researchers have observed passive attitudes toward decision-making among cancer patients; in fact, a recent research review has shown that passive attitudes remain dominant in patients 3 . Although many researchers accept the importance of shared attitudes in decision-making, these observations might be caused by differences in patient ethnicity, age 4,5 , and background experience 6 . According to a recent study, patients prefer to be controlled by the physician in decision-making; they trust their physician 7 .…”