When the Treatment Goal Is Not Cure: Are Cancer Patients Equipped to Make Informed Decisions?

Gattellari, Melina; Voigt, Katie; Butow, Phyllis; Tattersall, Martin H. N.

doi:10.1200/jco.2002.20.2.503

Cited by 236 publications

(123 citation statements)

References 45 publications

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“…Oncologists do discuss the goals of systemic therapy with advanced cancer patients, as well as its impact on prognosis and side effects. However, in an analysis of 118 audio-taped oncology consultations with advanced cancer patients, fewer oncologists discuss life expectancy, the patient's treatment preference and alternatives, such as supportive care alone (Gattellari et al, 2002). The impact of treatment on patient's quality of life was discussed in only onethird of consultations, and oncologists checked for patient understanding of information in only 10%.…”

Section: Discussionmentioning

confidence: 99%

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

et al. 2008

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We developed a decision aid (DA) for patients with metastatic non-small cell lung cancer (NSCLC), to better inform patients of their prognosis and treatment options, and facilitate involvement in decision-making. In a pilot study, 20 patients with metastatic NSCLC attending outpatient clinics at a major cancer centre, who had already made a treatment decision, reviewed acceptability of the DA. The median age of the patients was 61 years (range 37 -77 years), 35% were male, 20% had a university education, and most (75%) had English as a first language. Most had received chemotherapy, with 65% currently on treatment. Patients were not anxious at baseline and had clear understanding of the goals and toxicity of chemotherapy in advanced NSCLC. After reviewing the DA, patients' anxiety decreased slightly (P ¼ 0.04) and knowledge scores improved by 25% (Po0.001). Most improvements in understanding were of prognosis with and without chemotherapy, although patients still believed advanced NSCLC to be curable. Patients rated the DA highly with respect to information clarity, usefulness and were positive about its use in practice, although 40% found the prognostic information slightly upsetting. The DA for advanced NSCLC is feasible, acceptable to patients and improves understanding of advanced NSCLC without increasing patient anxiety.

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Section: Discussionmentioning

confidence: 99%

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

et al. 2008

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“…Interventions that may help correct misperceptions include: having family members present at meetings with doctors to ask additional questions and record information; explaining treatment options and treatmentrelated mortality and outcome estimates a number of times (either through the use of educational materials, particularly interactive educational materials such as CD-ROMs, or through repeat visits with health care personnel and reiteration of estimates); testing patient understanding of these estimates, to verify that informed consent truly has been given; and early involvement of psychiatry and social services, when appropriate. [49][50][51][52][53][54] …”

Section: Discussionmentioning

confidence: 99%

Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

et al. 2004

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Older patients with acute myeloid leukemia (AML) and advanced myelodysplastic syndrome (aMDS) must decide between receiving intensive induction chemotherapy (IC) or nonintensive chemotherapy/best supportive care (NIC). Little information exists about what factors influence treatment decisions and what quality of life (QOL) is associated with treatment choices. We prospectively examined 43 patients 60 years or older who were interviewed at diagnosis and periodically over 1 year. IC choice was associated with younger age (66 vs 76 years, P ¼ 0.01) and AML diagnosis, but not with performance status, comorbidities, or QOL. In total, 63% of all patients reported not being offered other treatment options despite physician documentation of alternatives. Patient and physician estimates of cure differed significantly: 74% of patients estimated their chance of cure to be 50% or greater, yet for 89% of patients physician estimates of cure were 10% or less. IC patients experienced decreased QOL at 2 weeks, but rebounded to baseline and to NIC levels by 6 weeks. Initial QOL is not associated with treatment choice in older AML and aMDS patients. Regardless of treatment choice, patients report not being offered treatment options and overestimate their chances of cure. In IC patients, QOL decreases during hospitalization but rebounds after discharge.

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“…Braddock et al (1999) analysed 1057 consultations of primary care physicians and surgeons in 1993 and found that only 11.3% included discussion of alternative treatment options and just 7.8% included pros and cons. An Australian study in 2001 of consultations with advanced cancer patients showed that only 27% of patients were offered a choice, and 44% were given information on an alternative course of action to anticancer therapy (Gattellari et al, 2002). In a Dutch study of advanced cancer patient care, acknowledgement of the medical oncology options of palliative chemotherapy or watchful waiting occurred in half of the consultations, with just 27% receiving extensive explanation of the watchful waiting option (Koedoot et al, 2004).…”

Section: Discrepancy Between Reported Comfort Levels and Usual Practisementioning

confidence: 99%

The context influences doctors' support of shared decision-making in cancer care

2007

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Most cancer patients in westernised countries now want all information about their situation, good or bad, and many wish to be involved in decision-making. The attitudes to and use of shared decision-making (SDM) by cancer doctors is not well known. Australian cancer clinicians treating breast, colorectal, gynaecological, haematological, or urological cancer were surveyed to identify their usual approach to decision-making and their comfort with different decision-making styles when discussing treatment with patients. A response rate of 59% resulted in 624 complete surveys, which explored usual practice in discussing participation in decision-making, providing information, and perception of the role patients want to play. Univariate and multivariate analyses were performed to identify predictors of use of SDM. Most cancer doctors (62.4%) reported using SDM and being most comfortable with this approach. Differences were apparent between reported high comfort with SDM and less frequent usual practice. Multivariate analysis showed that specialisation in breast or urological cancers compared to other cancers (AOR 3.02), high caseload of new patients per month (AOR 2.81) and female gender (AOR 1.87) were each independently associated with increased likelihood of use of SDM. Barriers exist to the application of SDM by doctors according to clinical situation and clinician characteristics.

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When the Treatment Goal Is Not Cure: Are Cancer Patients Equipped to Make Informed Decisions?

Abstract: Most patients were well informed, but important gaps remain, especially concerning information about prognosis and alternatives to anticancer treatment. These gaps invite the question concerning whether patients are led toward anticancer treatment.

Cited by 236 publications

References 45 publications

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

The context influences doctors' support of shared decision-making in cancer care

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