Patient preferences versus physician perceptions of treatment decisions in cancer care.
OBJECTIVE
To examine patient preferences as well as physician perceptions of these preferences for decision making and communication in palliative care.


METHODS
Medical decision-making preferences (DMPs) were prospectively studied in 78 assessable cancer patients after initial assessment at a palliative care outpatient clinic. DMPs were assessed with a questionnaire using five possible choices ranging from 1 (patient prefers to make the treatment decision) to 5 (patient prefers the physician to make the decision). In addition, the physician's perception of this preference was assessed.


RESULTS
Full concordance between the physician and the patient was seen in 30 (38%) of 78 cases; when the five original categories were recombined to cover active, shared, and passive decision making, there was concordance in 35 (45%) of 78 cases. The kappa coefficient for agreement between physician and patient was poor at 0.14 (95% confidence limit, -0.01 to 0.30) for simple kappa and 0.17 (95% confidence interval [CI], 0.00 to 0.34) for weighted kappa (calculated on the three regrouped categories). Active, shared, and passive DMPs were chosen by 16 (20%) of 78, 49 (63%) of 78, and 13 (17%) of 78 patients, and by 23 (29%) of 78, 30 (39%) of 78, and 25 (32%) of 78 physicians, respectively. The majority of patients (49 [63%] of 78; 95% CI, 0.51 to 0.74) preferred a shared approach with physicians. Physicians predicted that patients preferred a less shared approach than they in fact did. Patient age or sex did not significantly alter DMP.


CONCLUSIONS
An individual approach is needed and each patient should be assessed prospectively for DMP.
Bruera
E
E
Department of Symptom Control and Palliative Care, University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA. ebruera@mdanderson.org
Sweeney
C
C
Calder
K
K
Palmer
L
L
Benisch-Tolley
S
S
D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011446:Prospective Studies