Physician, Patient, and Contextual Factors Affecting Treatment Decisions in Older Adults With Cancer and Models of Decision Making: A Literature Review

Abstract

Purpose/Objectives To review physician, patient, and contextual factors that affect treatment decision-making in older adults diagnosed with cancer and relate these factors to theoretical models of decision-making. Data Sources PubMed (1966-April 2010), PsycINFO (1967-April 2010) and CINAHL (1982-April 2010) databases were searched to access relevant medical, psychological and nursing literature. Data Synthesis Physician factors in treatment decisions include physician personal beliefs and values, expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors include personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors include availability of caregiver, lack of insurance, poor financial status, and geographical barrier. The interplay of physician, patient, and contextual factors are not well understood. Existing models of decision-making are not sufficient to explicate TDM process in older adults diagnosed with cancer. Conclusions Clinical studies in older adult patient population using a longitudinal and prospective design are needed to examine real-time interplay of patient, physician, and contextual factors and to better understand how these divergent factors influenced actual treatment decisions. Implications for Nursing Oncology nurses can advocate for a patient’s autonomy during TDM by coaching them to seek evidence-based discussion of various treatment options, benefits and risks assessments, and truthful discussion of the probability of success for each treatment option from their physicians. Oncology nurses must promote an informed treatment decisions that are consistent with a patient’s personal preference and values within the limits of the patient’s personal contexts.

Patient characteristics and treatment considerations in pancreatic cancer: a population based study in the Netherlands

“…Patient's choice was the most prevalent reason (27%). Although older age appears to increase the preference for a more passive role in the decision-making process [26], our results are in line with the previously reported percentage of octogenarians who chose to withhold treatment (29%) [13]. The fact that a large proportion of patients decided to withhold treatment could indicate that they play a role in the decision-making process.…”

Factores que influyen las decisiones terapéuticas en Ortodoncia: Revisión de la literatura. Decisiones terapéuticas en Ortodoncia

“…This is one of the most frequently used methods to clarify doubts regarding ethical issues 25 . However, sometimes clinicians choose not to include colleagues from other fields, as found by Tariman, whose study states that only 14% of oncologists believe that primary care physicians should be more involved with therapeutic decisions 15 .…”

“…This has led to women with cancer being undertreated because physicians believe that they have a low life expectancy 15 .…”

“…This entails allowing for more or less patient participation when selecting a given therapy 15 . Likewise, personal beliefs have a direct impact on the decision.…”

“…These include the education received in graduate and postgraduate school [3][4][5][6][7][8][9][10][11] , personal preferences 12 and the mastery of different techniques 13,14 , personal characteristics and values 15 , the patient's clinical and financial situation 16 , and the dentist-patient relationship 17 , among others.…”