Preferences for involvement in treatment decision making of patients with cancer: A review of the literature

Abstract

SummaryA systematic review of the literature about patients' preferences for involvement in cancer treatment decision making was conducted. Establishing preferences is important if the aim is to make health care more sensitive to the needs and expectations of each individual patient. Thirty-one papers were included in the review. Generalising from this literature is problematic because of limitations related to sample size, sample composition and methods used to assess preferences. Whilst we take cognizance of these limitations, research suggests that preferences vary considerably and that whilst most patients prefer a collaborative role, a significant minority prefer a passive or active role. Evidence about the association of factors such as age, gender, level of education, marital status, socioeconomic status and health status with preferences is inconclusive. Only a handful of studies investigated the degree of congruence between patients' role preferences and the actual role that they perceived they had played, which highlight that some patients experience a dissonance between the two. Similarly, few studies investigated the impact of this dissonance on patient anxiety or satisfaction with the treatment decision. We advocate more rigorous investigations before recommendations for health care professionals can be processed with confidence.

Patient participation – to what extent? A survey of patients’ perspectives

“…A cross-sectional study of haematological patients in Australia showed that 44% experienced a mismatch between preferred and perceived degree of participation; of those, 34% had been less involved than they desired [16] . These results correspond to findings in two reviews concluding that patients want more participation than they had actually experienced [17,18] . Yet, we found a higher proportion of patients experiencing a mismatch and furthermore that this mismatch was a result of being involved to a higher degree than desired.…”

“…According to Hubbard et al, younger patients tend to prefer more involvement than older patients although no association between health status and role preferences can be claimed to exist [17] . The slight underrepresentation of young patients in our study may thus have contributed to the finding that the majority of respondents preferred staff to make the decisions.…”

Readiness to engage in treatment decision-making during initial surgical oncology consultation for early stage breast cancer

“…Consistent with findings from other studies [40][41][42] almost two-thirds of women in this study preferred an active role (collaborative or patient-based) in treatment decision-making. Women who are involved in decision-making at a level that is consistent with or greater than their preferred role have better overall decision related outcomes [43] .…”

Older patients and their GPs: shared decision making in enhancing trust

“…Participants recognised that, independent of multimorbidity, age brings greater expectations of health care, 24 but that societal views can influence preferences for shared decision making. 55 The particular influence of other factors on associations between patients' trust is highlighted, and the facilitation of shared decision making, with respect to older patients and the GP. Continuity of care, 56,57 and patient choice for a GP-patient 'match', 51,58 have been associated with patients' trust.…”