Elsevier

Radiotherapy and Oncology

Volume 117, Issue 2, November 2015, Pages 338-342
Radiotherapy and Oncology

Patient values and treatment preferences
Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision making

https://doi.org/10.1016/j.radonc.2015.09.005Get rights and content

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.

Section snippets

Study population

This study was conducted in six of the 21 radiotherapy centres in The Netherlands in the context of a large multicentre study on communication and treatment decision making during decision consultations on PRT for rectal cancer [18]. All patients eligible for short-course PRT followed by a low-anterior resection (sphincter-saving operation) were eligible for inclusion.

All radiation oncologists working in one of these centres and treating patients with rectal cancer were asked to participate.

Procedure

Results

We approached 128 eligible patients, all diagnosed between November 2010 and April 2014. Twelve patients (9%) could not be reached and twenty-one (17%) refused to participate. Ninety-five patients (74%) agreed to have their consultation audiotaped. Five of them were excluded from the analyses because of incomplete audiotaping. Of the remaining 90 patients, 60 (67%) completed the post-consultation questionnaire, a median of 4 days after the consultation (range, 0–13). No significant differences

Discussion

The SDM model states that after informing patients on possible treatment options, possible benefits and harms and their respective probabilities, patients’ values and preferences should be clarified or elicited in the decision making process [2], [14], [15].

The first aim of this study was to assess the extent to which rectal cancer patients voice their values regarding benefits and harms of PRT and their treatment preferences during decision consultations. In less than half of the

Funding

This work was supported by the Dutch Cancer Society (Grant No. UL2009-4431). The study sponsor had no involvement on the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for publication.

Conflict of interest

The authors have declared no conflicts of interest.

Acknowledgements

We thank all participating patients and radiation oncologists for their efforts.

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