Importance of quality‐of‐life priorities and preferences surrounding treatment decision making in patients with cancer and oncology clinicians

• Published in: Cancer 2020-08, Vol.126 (15), p.3534-3541
• Main Authors: Williams, Courtney P., Miller‐Sonet, Ellen, Nipp, Ryan D., Kamal, Arif H., Love, Susan, Rocque, Gabrielle B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Breast Neoplasms - psychology; Breast Neoplasms - therapy; Cancer; Clinical decision making; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - pathology; Colorectal Neoplasms - psychology; Colorectal Neoplasms - therapy; Costs; Decision making; Decision Making, Shared; Documentation; Female; Humans; Male; Middle Aged; Neoplasms - epidemiology; Neoplasms - pathology; Neoplasms - psychology; Neoplasms - therapy; Oncologists - psychology; Oncology; oncology clinicians; Patient Care Planning; Patient Participation - psychology; Patient Preference - psychology; patient preferences; Patients; Physician-Patient Relations; Polls & surveys; Priorities; Quality; Quality of Life; quality of life (QoL); Questions; shared decision making (SDM)
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.32961

Background Shared decision‐making (SDM) occurs when a patient partners with their oncologist to integrate personal preferences and values into treatment decisions. A key component of SDM is the elicitation of patient preferences and values, yet little is known about how and when these are elicited, communicated, prioritized, and documented within clinical encounters. Methods This cross‐sectional study evaluated nationwide data collected by CancerCare to better understand current patterns of SDM between patients and their oncology clinicians. Patient surveys included questions about the importance of quality‐of‐life preferences and discussions regarding quality‐of‐life priorities with their clinicians. Clinician surveys included questions about the discussion of quality‐of‐life priorities and preferences with patients, the effect of quality‐of‐life priorities on treatment recommendations, and quality‐of‐life priority documentation in practice. Results Patient survey completers (n = 320; 33% response rate) were predominantly women (95%), had a diagnosis of breast cancer (59%), or were receiving active cancer treatment (59%). Clinician survey completers (n = 112; 5% response rate) predominately identified as hematologists or oncologists (66%). Although 67% of clinicians reported knowing their patients' personal quality‐of‐life priorities and preferences before finalizing treatment plans, only 37% of patients reported that these discussions occurred before treatment initiation. Most patients (95%) considered out‐of‐pocket expenses important during treatment planning, yet only 59% reported discussing out‐of‐pocket expenses with their clinician before finalizing treatment plans. A majority of clinicians (52%) considered clinic questionnaires as feasible to document quality‐of‐life priorities and preferences. Conclusions Patients and clinicians reported that preferences related to quality‐of‐life should be considered in treatment decision making, yet barriers to SDM, preference elicitation, and documentation remain. Most surveyed patients with cancer identify personal quality‐of‐life priorities as important when making cancer treatment decisions, yet a minority reports discussing these priorities with their oncology clinician before beginning treatment. Both patients and clinicians report that diverse preferences related to quality of life should be considered in treatment decision making, yet barriers to shared decision‐making, preference elicitation, and docume