Cancer Patients Associated Shared-Decision Making With Quality Care

Cancer patients with less involvement in their treatment decisions are less likely to report excellent quality of care even if they prefer physician-controlled decisions, according to a study in JAMA Oncology.

The researchers surveyed 5315 patients diagnosed with lung and/or colorectal cancer between 2003 and 2005 about their preferred roles in cancer treatment decisions and their actual roles in decisions. The investigators assessed the associations between patients’ actual roles in treatment decisions and patient-reported quality of care for surgery, chemotherapy and/or radiation, and patient ratings of physician communication.

The survey participants were from the Cancer Care Outcomes Research and Surveillance study and included patients living within Northern California, Los Angeles County, North Carolina, Iowa, or Alabama. Patients were surveyed 3 to 6 months after their diagnosis of lung and/or colorectal cancer. Colorectal cancer was most common (56%), followed by non-small cell lung cancer (40%), and small cell lung cancer (5%).

“Among patients with newly diagnosed lung and colorectal cancer who made decisions about surgery, chemotherapy, and/or radiation therapy, patients who experienced physician-controlled vs shared decision making were less likely to report excellent quality of care and top ratings of physician communication,” the authors wrote.

More than half of patients (58%) preferred shared decision-making roles about their cancer treatment, while only 6% preferred physician-controlled decisions, and the last 36% preferred patient-controlled decisions.

However, among the nearly 11,000 treatment decisions made by the surveyed patients, only 44% were categorized as shared, 17% were physician controlled, and 39% were patient controlled.

The patient’s preferred role in decision making was not associated with ratings of quality, which implies, according to the researchers, that shared decision making is associated with higher perceived quality.

“Given the increasing emphasis on patient experiences and ratings in health care, these results highlight the benefits of promoting shared decision making among all patients with cancer, even those who express preferences for less active roles,” the authors concluded.