DECISION CONSULTATIONS ABOUT (NEO-)ADJUVANT CANCER TREATMENT: PATIENT AND ONCOLOGIST QUESTIONS AS A VEHICLE TO PROMOTE SHARED DECISION MAKING

Purpose:

This study aimed to assess a) the number/topics of invited/uninvited questions from cancer patients and their companions; b) the number/type of non-anamnestic questions from oncologists, in particular about patients’ understanding and preferences; and c) if patients/companions’ or oncologists’ questions were associated with patient age/education.

Methods:

Secondary analyses were performed on N=100 audiotaped decision consultations of N=51 rectal cancer and N=49 breast cancer patients about (neo-)adjuvant treatment. Separate coding schemes were developed and applied by two coders (interrater agreement: range κ, 0.89-0.98).

Results:

The patients/companions asked Md=8/Md=4 questions per consultation. Higher educated patients asked significantly more questions (P=0.01). The patients/companions’ questions related most to treatment procedures and harms. In 56/100 consultations, the oncologists asked 1-4 times if patients/companions had questions, after Md=85% of the consultation time had passed. Oncologists’ invitation was not associated to the number of patient/companion questions. The oncologists asked Md=6 non-anamnestic questions per consultation, including on average 34% medical questions (“Who is your surgeon?”), 25% questions about patients’ preferences, 16% questions about patients’ existing knowledge, and 15% checks of understanding/agreement. The oncologists asked Md=1 question to ascertain prior knowledge. They further asked Md=1 about preferences and none to 39/100 patients. The number of non-anamnestic questions overall and specifically about existing knowledge or preferences were not significantly related to patients’ age/education. Preference questions related most often to treatment procedures, preferences for receiving probability information, or informed consent.

Conclusion:

Patients and companions tend to ask few questions about a limited number of topics, and notably procedures. The oncologists explicitly invited questions in half of the consultations but did so late in the consultation, which may explain the limited number of ensuing patient/companion questions. Oncologists asked about patients’ preferences and these related seldom to treatment benefits/harms. Patients may gain from asking more non-procedural questions about options to become better-informed while oncologists could ask more about preferences to better understand their patients’ priorities.