QUALITY OF LIFE AND SHARED DECISIONS IN PATIENTS WITH HIGH GRADE GLIOMAS
claudio Lucchiari, PhD1, gabriella Pravettoni2, gianluca Vago2, and Amerigo Boiardi1. (1) National Neurological Institute, Milan, Italy, (2) State University of Milan, Milan, Italy
Purpose The present study was aimed at evaluating subjective and objective indexes of health related quality of life in patients grouped by different shared decision preferences. Methods In order to analyze preferences of patients with high grade gliomas, a cancer diagnosis with poor life expectations, we collected data about 82 inpatients, treated between 2003 and 2005 in the National Neurological Institute “Carlo Besta” of Milan. We used both standardized instruments and an half-structure interview concerning several subjective domains about decision involvement, quality of life and personal satisfaction. In particular, we submitted the Need Evaluation Questionnaire (Tamburini et al., 1999) to evaluate patient's unmet need during the hospitalisation. The Functional Assessment Cancer Therapy for brain cancer population (Fact-Br; Cella et al., 2005) was used to assess health related quality of life. The Karnofsky Performance Score was attributed by the physician in charge. We classified patients for preferences about share decisions into three clusters (low, medium and high involvement need) and we compared them for quality of life and other subjective domains (such as therapeutic satisfaction) through a non parametric test (the Kruskal-Wallis test). Results Our data showed that no differences were present in quality of life, as measured by the Fact-Br instrument, between the three clusters. Mean values found were 54,2, 55,5 and 55,1 respectively for low, medium and high clusters. However subjects in the cluster three (high involvement) reported higher scores on satisfaction, confidence and trust in the therapies. Data were not affected by the KPS value interaction (all patients had a KPS higher or equal 60). Conclusions The present study suggests that share decision might contribute to a better adaptation process to the illness. Patients with a met need of high decisional involvement seem to be more satisfied of the therapeutic journey also in a difficult situation such as of a malignant brain cancer. Furthermore, it seems that sharing decision might help the medical work enhancing the patient's compliance (Schttner et al. 2004).