Shared decision-making in breast cancer: discrepancy between the treatment efficacy required by patients and by physicians

Abstract

Several factors can influence individual perceptions of the expected benefit of recommended adjuvant treatment for breast cancer. This study investigated differences between patients and physicians with regard to the required efficacy of treatment and the factors influencing patients' and physicians' willingness to accept different therapeutic options. A total of 9,000 questionnaires were distributed to patients with breast cancer, and 6,938 questionnaires were distributed to physicians treating breast cancer patients. The patients were asked for personal information and about their medical history and experiences during treatment. The physicians were asked about personal information and their specialty and work environment. The treatment efficacy required by the two groups was assessed using six virtual cases of breast cancer and the treatment regimens proposed, with specific benefits and side effects. A total of 2,155 patients and 527 physicians responded to the questionnaire (return rates of 23.9 and 7.6 %). Significantly different ratings between patients and physicians with regard to the expected benefit of certain treatment options were observed. The differences were noted not only for chemotherapy but also for antihormonal and antibody treatments. Whereas physicians had a quite realistic view of the expected treatment benefits, the patients' expectations were varied. Approximately one-fifth of the patients were willing to accept treatment regimens even with marginal anticipated benefits, whereas one-third required unrealistic treatment benefits. Several influencing factors that were significantly associated with the quality rating of treatment regimens in the groups of breast cancer patients and physicians were also identified. In contrast to physicians, many breast cancer patients required treatment benefits beyond what was realistically possible, although a large group of patients were also satisfied with minimal benefits. Individual factors were also identified in both groups that significantly influence thresholds for accepting adjuvant treatment, independently of risk estimates and therapy guidelines.

A Prospective Comparison of Younger and Older Patients' Preferences for Adjuvant Chemotherapy and Hormonal Therapy in Early Breast Cancer

“…However, the proportion of older participants willing to accept systemic therapy was large (3 out of 5 women, for both aCT and aHT), and for these older women, the minimally-required benefit did not differ from that of younger women. The latter finding is in line with other studies on aCT that found no association between age and minimally-required benefit, in terms of overall [9][10][11] or disease-free survival, 7 but not with other studies demonstrating in contrast that higher age was related to higher minimally-required benefit from aCT 25,26 or aHT. 26 However, our study as well as earlier studies 7,[9][10][11] showing no such association differ from the latter two 25,26 regarding design and population in the following way.…”

Implementing and evaluating shared decision making in oncology practice

“…However, in another review, Zafar et al explained that patients struggle with balancing survival with quality of life, and these preferences can evolve over the course of treatment; in 1 study, patients who had undergone treatment were willing to trade‐off survival benefit for quality of life in hypothetical scenarios . Patients and physicians may also express significant differences in the perceived benefits of certain treatment options and in the most important treatment side effects . For example, individuals receiving adjuvant breast cancer treatment may have greater concerns about side effects that affect their quality of life (eg, loss of libido, fatigue, hot flashes), whereas physicians have different concerns about treatment‐related adverse events .…”

Adaptation and qualitative evaluation of encounter decision aids in breast cancer care

“…Within this process, the physician supports the patient to weigh the benefits and risks as well as possible consequences of different treatment options [9]. Since patients and physicians appraise the quality of different treatment options differently [10], it is important to encourage a dialogue and come to a shared understanding of what the best option for the individual patient is.…”