title: Oncologists' assessments of lung cancer patient and family disagreements regarding treatment decision making.
abstract: BACKGROUND
  Disagreements between cancer patients and their caregivers about treatment and care can affect the patient's physical and mental well-being. Therefore it is important to understand if oncologists can accurately identify the presence of patient-caregiver decisional conflict. This study examined assessments made by lung cancer patients, their caregivers, and their oncologists regarding patient-caregiver disagreements concerning treatment and care decisions.
  
  
  METHODS
  We assessed the extent to which the patient, caregiver, and oncologist reported disagreement between the patient and the family member regarding treatment decisions in 134 patient-caregiver-oncologist triads. Descriptive statistics were used to explore rates of concordance amongst all possible combinations of raters. Loglinear models were tested for 3-way agreement.
  
  
  RESULTS
  Most patient-caregiver pairs, 82.1% (n = 110), reported agreement concerning presence or absence of decisional conflict. Oncologists were more successful in detecting absence of conflict than the presence of conflict. When the caregiver and the oncologist agreed, it was regarding the absence of conflict (64.9%), rather than the presence of conflict. In 10.6% (n = 15) of cases, oncologists reported that conflictual relationships negatively impacted their ability to provide patient care.
  
  
  CONCLUSIONS
  Recent models of cancer patient care promote including the caregiver fully in the process while respecting the primacy of the patient's perspective. However, these models assume that the oncologist will recognize when disagreements exist and be able to assist in conflict resolution. The degree to which the oncologist identified that conflict exists and implications for their ability to provide patient care when familial disagreements existed are discussed.
authors.affiliation: Department of Social and Behavioral Health, Massey Cancer Center, School of Medicine, Virginia Commonwealth University, VA 23298, USA. lasiminoff@vcu.edu
authors.forename: Laura A
authors.initials: LA
authors.lastname: Siminoff
authors.forename: Lindsey
authors.initials: L
authors.lastname: Dorflinger
authors.forename: Amma
authors.initials: A
authors.lastname: Agyemang
authors.forename: Sherman
authors.initials: S
authors.lastname: Baker
authors.forename: Maureen
authors.initials: M
authors.lastname: Wilson-Genderson
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers; D003657:Decision Making; D034462:Dissent and Disputes; D005260:Female; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D020380:Needs Assessment; D057240:Patient Preference; D010819:Physician's Role; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires