Jana Arnholdt1, Jörg Haier2. 1. Comprehensive Cancer Center Münster, University Hospital Münster, Münster, Germany. 2. University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Martinistr. 52 (O24), 20246, Hamburg, Germany. joerg.haier@nordakademie.de.
Abstract
PURPOSE: Shared decision-making is based on comparable understanding of decision criteria on both sides that requires knowledge about preferences, reception/prioritization of benefits and covariates influencing these criteria. We addressed identification of cancer patients' preferences for treatment decisions and covariates for preference patterns in certain patient cohorts. DESIGN: Using preference surveys ordinal ranking of decisional preferences in life (PL) and during therapy (PT) were obtained and aggregated by factorial analysis. Demographic and clinical data enabled clustering of patient groups including non-malignant control group with distinct preference patterns. Covariates for these patterns were determined by multivariate ANOVA. RESULTS: 1777 cancer and 367 non-oncological patients (≥18 years) were evaluable (response 56.0%). Patient-reported PT was grouped into distinctive categories: immediate treatment effectivity, long-term effects and survival, empathy, easy treatment and employability/healing. Gender, parenthood, family status, age and educational level mainly determine importance of PL (52.1% variance) and PT (55.1% variance) enabling discrimination of specific preference patterns in patients: older males, non-single, younger males, non-single female with children and young, single patients without children that mainly significantly differed from non-cancer patients (p < 0.001). CONCLUSION: Relevance of decisional PL/PT appears to be cancer-specific and distinct between cancer patient groups. If patients recognize direct social responsibility, immediate treatment effects gain importance accompanied by reduced impact of employability, rehabilitation and financial security. For young and independent patients empathy has similar impact as treatment effects. Consequently, clinical research should consider age-specific endpoints and distinct decisional preferences to match patients' perspective by specific evidence.
PURPOSE: Shared decision-making is based on comparable understanding of decision criteria on both sides that requires knowledge about preferences, reception/prioritization of benefits and covariates influencing these criteria. We addressed identification of cancerpatients' preferences for treatment decisions and covariates for preference patterns in certain patient cohorts. DESIGN: Using preference surveys ordinal ranking of decisional preferences in life (PL) and during therapy (PT) were obtained and aggregated by factorial analysis. Demographic and clinical data enabled clustering of patient groups including non-malignant control group with distinct preference patterns. Covariates for these patterns were determined by multivariate ANOVA. RESULTS: 1777 cancer and 367 non-oncological patients (≥18 years) were evaluable (response 56.0%). Patient-reported PT was grouped into distinctive categories: immediate treatment effectivity, long-term effects and survival, empathy, easy treatment and employability/healing. Gender, parenthood, family status, age and educational level mainly determine importance of PL (52.1% variance) and PT (55.1% variance) enabling discrimination of specific preference patterns in patients: older males, non-single, younger males, non-single female with children and young, single patients without children that mainly significantly differed from non-cancerpatients (p < 0.001). CONCLUSION: Relevance of decisional PL/PT appears to be cancer-specific and distinct between cancerpatient groups. If patients recognize direct social responsibility, immediate treatment effects gain importance accompanied by reduced impact of employability, rehabilitation and financial security. For young and independent patients empathy has similar impact as treatment effects. Consequently, clinical research should consider age-specific endpoints and distinct decisional preferences to match patients' perspective by specific evidence.
Authors: Heide Götze; Jochen Ernst; Oliver Krauss; Gregor Weissflog; Reinhold Schwarz Journal: Z Psychosom Med Psychother Date: 2007 Impact factor: 0.791