Peer-Reviewed Journal Details
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Bruera, E and Sweeney, C and Calder, K and Palmer, L and Benisch-Tolley, S;
Journal of Clinical Oncology
Patient preferences versus physician perceptions of treatment decisions in cancer care
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Purpose: To examine patient preferences as well as physician perceptions of these preferences for decision making and communication in palliative care. Patients and Methods: Medical decision-making preferences (DMPs) were prospectively studied in 78 assessable cancer patients after initial assessment at a palliative care outpatient clinic. DMPs were assessed with a questionnaire using five possible choices ranging from 1 (patient prefers to make the treatment decision) to 5 (patient prefers the physician to make the decision). In addition, the physician's perception of this preference was assessed. Results: Full concordance between the physician and the patient was seen in 30 (38\%) of 78 cases; when the five original categories were recombined to cover active, shared, and passive decision making, there wets concordance in 35 (45\%) of 78 cases. The kappa coefficient for agreement between physician and patient was poor at 0.14 (95\% confidence limit, -0.01 to 0.30) for simple kappa and 0.17 (95\% confidence interval [CI], 0.00 to 0.34) for weighted kappa (calculated on the three regrouped categories). Active, shored, and passive DMPs were chosen by 16 (20\%) of 78, 49 (63\%) of 78, and 13 (17\%) of 78 patients, and by 23 (29\%) of 78, 30 (39\%) of 78, and 25 (32\%) of 78 physicians, respectively. The majority of patients (49 [63\%] of 78; 95\% CI, 0.51 to 0.74) preferred a shared approach with physicians. Physicians predicted that patients preferred a less shared approach than they in fact did. Patient age or sex did not significantly alter DMP, Conclusion: An individual approach is needed and each patient should be assessed prospectively for DMP.
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