Discrepancies between patient and physician estimates for the success of stem cell transplantation.
BACKGROUND
Stem cell transplantation is associated with considerable morbidity and mortality. The extent to which patients and their physicians correctly estimate these risks is unknown.


OBJECTIVE
To measure the expectations of patients and physicians prior to stem cell transplantation and correlate them with actual outcomes after transplantation.


METHODS
Prospective cohort study with baseline questionnaire administered July 1996 through November 1999 and follow-up to May 2000.


METHODS
Tertiary care transplant center in the United States.


METHODS
Of 458 surveys mailed, evaluable returned surveys were included for 313 autologous and allogeneic stem cell transplantation patients and their physicians.


METHODS
Patient and physician expectations prior to transplantation (measured on 6-point Likert scales) of treatment-related mortality, cure with transplantation, and cure without transplantation; actual treatment-related mortality and disease-free survival among patients with at least 1 year of follow-up after transplantation (n = 263).


RESULTS
Both patients and physicians were fairly accurate in estimating treatment-related mortality when actual mortality was less than 30%. However, in situations in which mortality was higher than 30%, such as with allogeneic transplantation for intermediate or advanced disease, physician expectations were lower, while patients remained optimistic. Similarly, physicians provided lower estimates of disease-free survival in cases of intermediate or advanced disease while patient expectations remained high and constant regardless of disease stage.


CONCLUSIONS
Patients and their physicians have the most concordant and accurate expectations when the outcome of stem cell transplantation is likely to be favorable. However, patients with more advanced disease fail to recognize the higher risks associated with their situations.
Lee
S J
SJ
Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA. stephanie_lee@dfci.harvard.edu
Fairclough
D
D
Antin
J H
JH
Weeks
J C
JC
D000328:Adult; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D011446:Prospective Studies; D012306:Risk; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States