title: Treatment of bone metastases with palliative radiotherapy: patients' treatment preferences.
abstract: OBJECTIVE
  To determine the proportion of patients undergoing palliative radiotherapy (RT) for bone pain who would like to participate in the decision-making process, and to determine their choice of palliative RT regimen (2000 cGy in five fractions vs. 800 cGy in one fraction) for painful bone metastases.
  
  
  METHODS
  Eligible patients were approached and all patients agreeing to participate provided written informed consent. Patients' decisional preferences were studied using a five-statement preference instrument. A decision board was used to help patients decide their preferred palliative RT regimen. Factors influencing patients' choices were studied using a visual analog scale.
  
  
  RESULTS
  A total of 101 patients were enrolled in the study (55 women and 46 men). The preferences for decision-making were as follows: 30 active, 47 collaborative, and 24 passive. Most (55 [76%] of 72) patients favored one fraction of palliative RT (95% confidence interval, 65-86%). Patients were more likely to select the 800 cGy in one fraction because of the convenience of the treatment plan (odds ratio, 1.024; 95% confidence interval, 1.004-1044) but were less likely to choose it because of the chance of bone fracture (odds ratio, 0.973; 95% confidence interval, 0.947-1.000) compared with 2000 cGy in five fractions.
  
  
  CONCLUSIONS
  Most participating patients preferred to decide either by themselves or with the radiation oncologists which treatment option they preferred. An 800-cGy-in-one-fraction regimen was favored, independent of the treated site. The convenience of the treatment plan and the likelihood of bone fracture were the most important factors influencing patients' choice.
authors.affiliation: Rapid Response Radiotherapy Program, Bone Metastases Site Group, Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, ON, Canada. ewa.szumacher@sw.on.ca
authors.forename: Ewa
authors.initials: E
authors.lastname: Szumacher
authors.forename: Hillary
authors.initials: H
authors.lastname: Llewellyn-Thomas
authors.forename: Edmee
authors.initials: E
authors.lastname: Franssen
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
authors.forename: Gerrit
authors.initials: G
authors.lastname: DeBoer
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: Charles
authors.initials: C
authors.lastname: Hayter
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barnes
authors.forename: Lourdes
authors.initials: L
authors.lastname: Andersson
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000556:secondary*; D016001:Confidence Intervals; D003657:Decision Making; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D010358:Patient Participation; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires