Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians

Abstract

Background:Vaginal brachytherapy (VBT) in high–intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making.Methods:Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making.Results:Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, P<0.001), for irradiated than for non-irradiated patients (median=0 vs 6.5%, P<0.001), and for radiation oncologists than for gynaecologists (median=4 vs 13%, P<0.001). Substantial variation existed within the groups of patients and clinicians. Participants preferred the patient and clinician to share in the decision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making.Conclusions:We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.

Patient Preference for Aggressive Medication Therapies with Potentially Stronger Adverse Drug Reactions Revealed Using a Scenario-based Survey

“…These results are supported by previous studies 7,9) that compared the preference for aggressive therapies between groups of patients and physicians. A questionnaire study 7) for patients with solid cancer found that 53.1％ of patients accepted intensive chemotherapy even if the chance of a cure was only 1％.…”

“…However, only 20.0％ of medical oncologists and 12.4 ％ of general practitioners accepted the chemotherapy. Another study 9) of patients with endometrial cancer found that patients were willing to accept a lower minimally desired beneˆt than physicians when considering vaginal brachytherapy. The present study found that a discrepancy for the accep- 9 (2017) tance of aggressive therapies existed between patients and pharmacists as well as between patients and physicians, and proved the fact on an individual level.…”

Nomograms for Prediction of Outcome With or Without Adjuvant Radiation Therapy for Patients With Endometrial Cancer: A Pooled Analysis of PORTEC-1 and PORTEC-2 Trials

“…In addition, they do wish to be involved in clinical decision making and be informed about the risk and benefits of alternative treatment options, and make an informed, joint decision together with their physician (9,10).…”

“…Patients should be aware of these facts and of the pros and cons of such treatment decisions and should be able to make their own informed choices (9). In a specific treatment preference study, EC patients reported a relatively low minimally desired benefit of VBT (0%-8%) at which they would prefer VBT over a watchful waiting approach (10). The current nomogram would be an easy and understandable instrument to be used in shared decision making, to facilitate understanding of the individual risk profile, and to discuss whether pelvic EBRT or VBT would be useful for the specific situation.…”

Shared decision making: Concepts, evidence, and practice

“…These behaviours would help patients in forming more stable preferences and would benefit patients in the long run. Similarly, in a survey on endometrial cancer decision making, Kunneman et al [44] showed that the majority of irradiated patients indicated that they had lacked room to think about benefits and harms of vaginal brachytherapy (42%), and give their opinion on benefits and harms (43%).…”