CONSIDERING PATIENT VALUES AND PREFERENCES ENHANCES PATIENT INVOLVEMENT IN RECTAL CANCER TREATMENT DECISION MAKING

Purpose:

The shared decision making (SDM) model states that in preference-sensitive decisions, patients’ values regarding benefits and harms of treatment and patients’ treatment preferences should be clarified or elicited, in choosing a strategy that best fits the individual patient. The objective of this study is to assess the extent to which values and preferences of rectal cancer patients are discussed and considered when the decision about preoperative radiotherapy (PRT) is made, 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 verbatim and coded using an adapted version of the ACEPP (Assessing Communication about Evidence and Patient Preferences) coding scheme to identify patients’ values concerning benefits and harms of PRT and their treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60).

 

Results:

Patients’ values were discussed in 38/90 consultations (42%), with maximum 4 values per consultation. Values were discussed for 10% of all benefits/harms addressed 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 considered patients’ values or preferences in deciding about PRT. Patients perceived a significant more active role in decision making if their values or preferences had been discussed or considered during the consultation.

 

Conclusion:

Our results suggest that enhancing the discussion of patient values and preferences will increase patients’ perceived involvement in the decision making process, which brings empirical support to this step within the SDM model.