Patient explicit consideration of tradeoffs in decision making about rectal cancer treatment: benefits for decision process and quality of life

Abstract

Introduction: Patient preferences are often not discussed in treatment decisions in oncology. We introduced an online values clarification method (VCM) to help newly diagnosed rectal cancer patients participate in shared decision making about short-course preoperative radiotherapy. Material and Methods: We offered a link to the VCM to a subset of consecutive patients before the pretreatment consultation with the radiation oncologist. Consultations were audiotaped and coded for expressions of patient preferences. Patients were asked to complete pre-and post-consultation questionnaires. Questionnaires assessed values clarity, decision regret and presence and impact of fecal incontinence and sexual problems. Results: Of 135 patients who had their consultation audiotaped and completed questionnaires, 35 received and accessed the VCM-link. Patients in the VCM-group slightly more often expressed preferences during consultations. Questionnaire data showed that patients in the VCM-group did not differ in how clear their values were, but experienced lower regret and less impact of treatment harms at 6 months follow-up; differences were non-significant but in the same direction at 12 months. Discussion: This is the first study to assess the effect of an adaptive conjoint analysis-based VCM on actual patient-clinician communication, and long-term decision regret and impact of treatment harms. Being explicitly invited to think about treatment benefits and harms seems to help patients to live with treatment consequences.

Fostering Patient Choice Awareness and Presenting Treatment Options Neutrally: A Randomized Trial to Assess the Effect on Perceived Room for Involvement in Decision Making

“…The study was powered on the primary outcome measure. In a previous (unpublished) study of our group, 49 we found a mean score on this 7-point scale of 5.06 with a standard deviation of 1.70. To be able to detect a difference of 0.5 in an analysis of variance (ANOVA) between-subjects analysis with a power of 80% and an alpha of 5%, 91 participants per experimental condition were needed (i.e., N = 364 participants in total).…”

Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life

“…The presented HRQoL effects of a stoma and major LARS in this study might provide information that can be used as patient information to assist in shared decision-making. Furthermore, explicit patient consideration of the trade-off between anastomosis or a stoma might positively influence the long-term quality of life and lead to a higher acceptance of possible consequences [48].…”

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

“…European studies demonstrate that the proportion of patients with colorectal cancer treated following national guidelines varies between 53 and 90%, with patient preference (27%) and functional status (20%) the most commonly reported reasons for adjusted treatment [ 46 ]. Nonetheless, patient involvement in perceiving personal preferences about the treatment is not systematic, especially in older patients [ 47 ]. Diefenhardt et al showed that in patients with rectal cancer, adherence to neoadjuvant chemo-radiotherapy was significantly associated with disease-free survival [ 44 ].…”