Patients' preferences for therapy in advanced epithelial ovarian cancer: development, testing, and application of a bedside decision instrument.
The objective of this study was to determine a patient's preference for treatment in the poor prognostic situation of advanced epithelial ovarian cancer. A standardized method of information transfer was developed and pretested for feasibility, acceptability, comprehension, interobserver reliability, and validity. The Decision Board (DB) describes to the patient who has completed surgery for suboptimally debulked ovarian cancer two treatment options, their potential side effects, and possible outcomes. The psychometric properties of the DB were determined in 37 volunteers without cancer and 11 women following first-line chemotherapy for ovarian cancer. The Board was then administered to 12 patients with stage IIIc and IV ovarian cancer at the point of deciding future chemotherapy. The feasibility of presenting poor prognostic information, patient comprehension in an emotionally charged situation, and her treatment choice were determined. Observation of patient-physician interviews revealed that survival information is not usually discussed on the initial consultation. Using the DB, it was feasible to provide survival information to 98% of the healthy women. Comprehension was high, with 96% of the questions being correctly answered. Interobserver reliability was high (kappa = 1.00). The construct that hypothesized that understanding information is a determinant of choice was verified, as 95.2% of women had predictable shifts in expressed preference. The strength of preference in healthy women was statistically significantly higher for Plan B (paclitaxel-cisplatin) than for Plan A (cisplatin-cyclophosphamide) (P < 0.001). The method of presenting survival information (median survival versus percentage survival at 3.5 years) influenced choice (P < 0.04). At the point of decision making, 33% of patients with advanced ovarian cancer chose Plan A and 67% chose Plan B. All volunteers and patients stated that they wanted to be fully informed of the choices of therapy for their disease and to be involved in treatment decisions. The DB is a reliable and valid method for sharing information about advanced ovarian cancer with patients. At the point of deciding first-line chemotherapy in this poor prognostic situation, patients still value survival more highly than the quality of life during chemotherapy.
Elit
L M
LM
Department of Obstetrics and Gynaecology, University of Western Ontario, London, Canada.
Levine
M N
MN
Gafni
A
A
Whelan
T J
TJ
Doig
G
G
Streiner
D L
DL
Rosen
B
B
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003657:Decision Making; D005260:Female; D006801:Humans; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D017239:Paclitaxel / Q000009:adverse effects / Q000627:therapeutic use; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate
D003520:Cyclophosphamide; D017239:Paclitaxel; D002945:Cisplatin