Decision-making input linked to more satisfied cancer patients

Breast Cancer News
April 23, 2014
Allison Bond

Last Updated: 2014-04-23 10:04:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Regardless of whether cancer patients sought to be involved in decisions about their treatment, those who were ended up more satisfied with their care, according to a recent study.

On the other hand, patients who didn't get to share in the decision process were twice as likely to report feeling anxious, depressed and fatigued.

"Now more than ever, we are really paying attention to the role of the patient in his or her own healthcare, and we are trying to make this more of a partnership (between physician and patient)," said Neha Vapiwala, an author of the study and a radiation oncologist at the Hospital of the University of Pennsylvania in Philadelphia.

The study, published in the journal Cancer, involved 305 patients at that hospital undergoing radiation therapy intended to cure their cancer. Participants had a wide variety of tumor types, including prostate, breast and lung cancer.

Participants filled out surveys at the end of their treatment to assess the decision-making style of their physician. Questions included, "If there were a choice between treatments, would your radiation oncologist ask you to help him/her make the decision?" and "How often does your radiation oncologist make an effort to give you some control over your treatment?"

The questionnaire also asked how often the patient had experienced depression, anxiety and extreme tiredness over the course of their treatment.

Vapiwala and her team found that a little under one-third of patients had the perception of having had control over their treatment decisions, and 76 percent reported they were very satisfied with their care.

Among participants who felt they had input into their treatment-related decisions, 84 percent said they were satisfied with their care, as compared to 71 percent who had not had such input.

The participants who felt they had helped make care-related decisions were more satisfied, regardless of whether they had actually sought such input.

In contrast, depression, fatigue and anxiety were significantly higher among patients who wanted to help make decisions about their treatment but did not feel they had been involved.

Among people in that category, 44 percent reported anxiety and depression and 68 percent were fatigued - compared to 20 percent with anxiety, 15 percent with depression and 33 percent with fatigue among those who wanted control and felt they had it.

"The main conclusion was that patients like to be part of the decision-making process. It is important for doctors to realize that we need to communicate with our patients and listen to them - we can't hear it too many times," said Dr. Kathryn Dusenbery, a radiation oncologist at the University of Minnesota in Minneapolis, who was not involved in the study.

Depending on the type and stage of cancer, there are many ways patients receiving radiation can be involved in their own care, from deciding when to do radiation treatments to choosing whether chemotherapy should be started before, during or after the radiation.

Patients also can play an important role in deciding how to treat the side effects that tend to accompany cancer treatment.

Although the study focused on cancer patients undergoing radiation, involvement in the decision-making process would likely benefit people receiving any type of medical care. Vapiwala encourages all patients to broach the subject with their provider.

"When a patient first meets with a physician - whether a primary care provider or a specialist - they can tell them whether they are the kind of person who likes to be more or less involved in parts of their care," Vapiwala told Reuters Health.

"Having a declaration might go a long way. It can't be ignored if the patient makes their needs known," she said.

And most doctors, Dusenbery said, "are pretty willing to listen." Patients shouldn't be afraid to bring up the subject, "and if they feel talked down to or put off, or not taken seriously, they need to find a new doctor."

She added, "It's a partnership; it's the two of you making a decision together."

SOURCE: Cancer, online March 19, 2014.

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