HYPOTHESIS: Patients and their clinicians hold varying preferences for surgical and adjuvant treatment therapies for rectal cancer. DESIGN: Preferences were determined using the Prospective Measure of Preference. SETTING: Royal Prince Alfred and St Vincent's hospitals in Sydney, Australia. PARTICIPANTS: Patients with colorectal cancer were interviewed during their postoperative hospital stay, and physicians were asked to complete a mailed survey. MAIN OUTCOME MEASURES: The Prospective Measure of Preference method produces 2 outcome measures of preference: willingness to trade and prospective measure of preference time trade-off. RESULTS: Patients' strongest preference was to avoid a stoma: more than 60% would give up a mean of 34% of their life expectancy to avoid this surgical option. This was followed by treatment options involving chemoradiotherapy, where more than 50% would give up a mean of almost 25% of their life to avoid treatment. Surgeons held stronger preferences against all adjuvant options compared with oncologists (P </= .01). CONCLUSIONS: Patients had strong preferences against all treatment options, and these preferences frequently differed from those of physicians. These results highlight the importance of determining patients' own preferences in the clinical encounter. Furthermore, the diversity of preferences of clinical subspecialists emphasizes the need for multidisciplinary treatment planning to ensure a balanced approach to treatment decision making for patients with rectal cancer.
HYPOTHESIS: Patients and their clinicians hold varying preferences for surgical and adjuvant treatment therapies for rectal cancer. DESIGN: Preferences were determined using the Prospective Measure of Preference. SETTING: Royal Prince Alfred and St Vincent's hospitals in Sydney, Australia. PARTICIPANTS: Patients with colorectal cancer were interviewed during their postoperative hospital stay, and physicians were asked to complete a mailed survey. MAIN OUTCOME MEASURES: The Prospective Measure of Preference method produces 2 outcome measures of preference: willingness to trade and prospective measure of preference time trade-off. RESULTS:Patients' strongest preference was to avoid a stoma: more than 60% would give up a mean of 34% of their life expectancy to avoid this surgical option. This was followed by treatment options involving chemoradiotherapy, where more than 50% would give up a mean of almost 25% of their life to avoid treatment. Surgeons held stronger preferences against all adjuvant options compared with oncologists (P </= .01). CONCLUSIONS:Patients had strong preferences against all treatment options, and these preferences frequently differed from those of physicians. These results highlight the importance of determining patients' own preferences in the clinical encounter. Furthermore, the diversity of preferences of clinical subspecialists emphasizes the need for multidisciplinary treatment planning to ensure a balanced approach to treatment decision making for patients with rectal cancer.
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Authors: Erin D Kennedy; Marko Simunovic; Kartik Jhaveri; Richard Kirsch; Jim Brierley; Sébastien Drolet; Carl Brown; Patrick M Vos; Wei Xiong; Tony MacLean; Selliah Kanthan; Peter Stotland; Simon Raphael; Gil Chow; Catherine A O'Brien; Charles Cho; Cathy Streutker; Raimond Wong; Selina Schmocker; Sender Liberman; Caroline Reinhold; Neil Kopek; Victoria Marcus; Alexandre Bouchard; Caroline Lavoie; Stanislas Morin; Martine Périgny; Ann Wright; Katerina Neumann; Sharon Clarke; Nikhilesh G Patil; Thomas Arnason; Lara Williams; Robin McLeod; Gina Brown; Alex Mathieson; Amandeep Pooni; Nancy N Baxter Journal: JAMA Oncol Date: 2019-07-01 Impact factor: 31.777