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ASCO 2014: Patients’ Actual Vs Preferred Decision-Making Roles

The Particulars: Previous research shows that shared decision making between patients and providers regarding cancer treatment is associated with improved outcomes. However, studies have also shown that patient preferences regarding their roles in treatment decisions can differ.

Data Breakdown: American investigators surveyed patients with lung or colorectal cancer about their preferred roles in treatment decisions and their actual roles in decisions about surgery, chemotherapy, and radiation. Associations between actual roles and patient-reported quality of care were also assessed. Among more than 8,000 decisions made by more than 5,000 patients, patients described 39.8% of decisions as patient-controlled, 47.1% as shared, and 13.1% as physician-controlled. Patients were more likely to report that they preferred a shared role (58.5%) or patient-controlled role (35.5%) as opposed to a physician-controlled role (6.0%). About two-thirds of patients who were involved in decision making described their quality of treatment as excellent. Those reporting physician-controlled decisions were the least likely to report excellent quality, regardless of their preferred role.

Take Home Pearls: For decisions regarding lung or colorectal cancer treatment, more active participation by patients appears to be associated with better reported quality of care. This association does not appear to vary by patients’ preferred roles in treatment decisions. The findings suggest that patients be included in treatment decisions, even when they report preferring that physicians make all decisions.

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