Marleen Kunneman1, Corrie A M Marijnen2, Monique C M Baas-Thijssen1, Yvette M van der Linden2, Tom Rozema3, Karin Muller4, Elisabeth D Geijsen5, Anne M Stiggelbout1, Arwen H Pieterse6. 1. Leiden University Medical Center, Department of Medical Decision Making, The Netherlands. 2. Leiden University Medical Center, Department of Radiotherapy, The Netherlands. 3. Verbeeten Institute, Tilburg, The Netherlands. 4. Radiotherapy Group Deventer, The Netherlands. 5. Amsterdam Medical Center, Department of Radiation Oncology, The Netherlands. 6. Leiden University Medical Center, Department of Medical Decision Making, The Netherlands. Electronic address: Pieterse@lumc.nl.
Abstract
BACKGROUND: The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancer patients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. METHODS: Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). RESULTS: Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. CONCLUSIONS: Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process.
BACKGROUND: The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancerpatients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. METHODS: Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). RESULTS:Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. CONCLUSIONS:Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process.
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