Desire for Information and Involvement in Treatment Decisions: Elderly Cancer Patients' Preferences and Their Physicians' Perceptions

Abstract

For older patients with advanced CRC, preferences for prognostic information and for an active role in treatment decision making are not easily predictable. Physicians' perceptions are often inconsistent with patients' stated preferences. Explicit discussion of preferred decision-making styles may improve patient-physician encounters.

A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey

“…Prior studies have emphasized age-based differences in decision-making preferences by comparing older adults with working-age adults, 10,11 or by focusing on targeted subgroups of older adults with low-literacy or poor health. 12,15 Our results corroborate findings from a recent systematic review indicating a trend toward greater patient preferences for active participation in health care decision-making, 28 and qualitative studies reporting substantial diversity in older adults' decisionmaking preferences. 15,29,30 This study provides new insight regarding the context in which many older adults manage their health, engage in health care decision-making, and experience health care demands.…”

“…12,15 Our results corroborate findings from a recent systematic review indicating a trend toward greater patient preferences for active participation in health care decision-making, 28 and qualitative studies reporting substantial diversity in older adults' decisionmaking preferences. 15,29,30 This study provides new insight regarding the context in which many older adults manage their health, engage in health care decision-making, and experience health care demands. Emerging evidence that patients commonly elect to involve family or close friends in routine or difficult treatment decisions 20,[31][32][33] has prompted elaborations of shared decision-making models that explicitly include family.…”

“…13,14 However, prior studies have typically emphasized age-related differences, 10,11 or focused on targeted subgroups of older adults with low-literacy, poor health, or specific conditions. [12][13][14][15][16] Understanding what people view to be important and their experience of care is foundational in the measurement of person-centered and family-centered care. 2 Therefore, we designed a study to understand older adults' preferences for participating in health care decision-making and their experiences with care as measured by aspects of treatment burden associated with managing health.…”

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

“…We found just one participant in our study who had previously discussed prognosis with their doctor, consistent with the contention that clinicians share prognosis less often than their patients would prefer. 29,[36][37][38] Participant perspectives in our study also supported those who have argued for clinician-initiated discussions of prognosis that are highly personalized, 17 empathic, 30 and begin with the explicit determination of each patient's preferences for discussion. 29 As evidence of the deeply personal nature of patient preferences for prognostic information, we noted that many patients viewed prognosis as uncertain, yet some saw this as a reason to avoid prognostic information, while others preferred that clinicians simply acknowledge uncertainty in their prognostic discussions (final quotes, Tables 2 and 3).…”

“…25,26 A limited number of studies from the advance planning literature also point to Latinos' unique perspectives on patient-doctor discussions around the end of life. 27,28 Additional studies have addressed how best to discuss prognosis given patients' preferences and perceived needs, 17,29,30 but we could find no deep, qualitative investigations of the reasons behind patient preferences for prognosis in a diverse elderly population. An in-depth understanding of the factors that motivate patients to desire or decline prognostic information, however, could enable clinicians to provide individualized and patient-centered care for diverse older adults in late life.…”