Patient’s Decisional Control Preferences of a Cohort of Patients With Advanced Cancer Receiving Palliative Care in India

Abstract

Context: Frequency of passive decisional control preferences (DCPs) has been variably reported but is generally higher among patients living in developing countries. Objectives: This prospective cross-sectional study aimed to determine the frequency of passive DCP among patients with advanced cancer in a tertiary cancer center in India and to identify its association with their sociodemographic and clinical characteristics. Methods: Patients with advanced cancer referred to palliative care (between March and August 2016) underwent assessment of DCP using validated tools including Control Preference Scale, Satisfaction with Decision Scale, and understanding of illness questionnaire. Information regarding patient characteristics including age, gender, education, marital status, employment, Karnofsky Performance Status Scale (KPS), cancer stage and type, and religion were also collected. Descriptive statistics and logistic regression analyses were performed. Results: Median age 48 years, Karnofsky 90, and 55.3% were men. Shared, active (patient prefers to make decision by his or her own), and passive DCP were 20.7%, 26.7%, and 52.7%, respectively (n ¼ 150). A total of 51.3% were satisfied by the way the actual decisions were made. Passive DCP did not vary across regions. Multivariate analysis shows that the active DCP was significantly associated with better KPS (exp B 1.07 [1.01-1.15], P ¼ .03). Conclusions: There are significant differences in DCP with KPS. Patients report a high level of satisfaction with their treatment decision-making process, though they have a poor understanding of their prognosis and goals of care and understand their treatment to be of curative intent. Individualized understanding of DCP and focus on illness understanding may be important for quality care and patient satisfaction outcomes.

Quality of Care among Non-Communicable Diseases (NCDs) Service Delivery in South Asia: A Systematic Rapid Review

“…In overall grading, among eight cross-sectional studies, four studies 22,23,26,31 were of good quality, three 25,28,33 were of moderate quality and one study 29 was found to have poor quality. As per the adapted grading system, the qualitative study 24 and non-randomized before-after intervention study 27 were graded as the good quality study as well.…”

“…No studies were found from Afghanistan, Bhutan, or the Maldives. Most of the (n = 10) intervention took place at the hospital or clinic level [21][22][23][24][25][26][27][28][29][30] whereas some (n = 3) were based on community setting [31][32][33] .…”

“…Majority of the included studies (n = 8) were cross-sectional 22,23,25,26,28,29,31,33 followed by RCTs (n = 3) 21,30,32 , nonrandomized before-after intervention study (n = 1) ( 27) and qualitative study (n = 1) 24 (Table 1).…”

“…Two studies discussed how a specialized hospital and palliative care centre for cancer could serve patients in a more engaging way 25 and how the decision-making process around treatment could be in uenced 34 . Services from a specialized cancer hospital had increased patient satisfaction (63%) related to the interpersonal relationship with their service provider (3.2 ± 0.5).…”

Reliability and validity of the Arabic translation of the palliative performance scale

“…For example, PS assessment helps in identifying patients with palliative care needs (Maas et al, 2013; Lee et al, 2019), and it is frequently included in the criteria of referral to outpatient palliative care (Hui et al, 2016). Furthermore, the PS of patients may have an impact on their decision-making preferences (Ghoshal et al, 2019).…”