title: Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians.
abstract: BACKGROUND
  Vaginal brachytherapy (VBT) in high-intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making.
  
  
  METHODS
  Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making.
  
  
  RESULTS
  Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, P<0.001), for irradiated than for non-irradiated patients (median=0 vs 6.5%, P<0.001), and for radiation oncologists than for gynaecologists (median=4 vs 13%, P<0.001). Substantial variation existed within the groups of patients and clinicians. Participants preferred the patient and clinician to share in the decision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making.
  
  
  CONCLUSIONS
  We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.
authors.affiliation: Leiden University Medical Center, Department of Medical Decision Making, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kunneman
authors.affiliation: Leiden University Medical Center, Department of Medical Decision Making, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: Pieterse
authors.affiliation: Leiden University Medical Center, Department of Medical Decision Making, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: Leiden University Medical Center, Department of Clinical Oncology, P.O. Box 9600 2300 RC Leiden, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Nout
authors.affiliation: Maastricht University Medical Center, Department of Obstetrics and Gynecology, P.O. Box 5800 6202 AZ Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kamps
authors.affiliation: MAASTricht Radiation Oncology Clinic, P.O. Box 3035 6202 NA Maastricht, The Netherlands.
authors.forename: L C H W
authors.initials: LC
authors.lastname: Lutgens
authors.affiliation: MAASTricht Radiation Oncology Clinic, P.O. Box 3035 6202 NA Maastricht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Paulissen
authors.affiliation: Rijnland Hospital, Department of Gynecology, P.O. Box 4220 2350 CC Leiderdorp, The Netherlands.
authors.forename: O J A
authors.initials: OJ
authors.lastname: Mattheussens
authors.affiliation: 1] Maastricht University Medical Center, Department of Obstetrics and Gynecology, P.O. Box 5800 6202 AZ Maastricht, The Netherlands [2] GROW, School for Oncology and Developmental Biology, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: R F P M
authors.initials: RF
authors.lastname: Kruitwagen
authors.affiliation: Leiden University Medical Center, Department of Clinical Oncology, P.O. Box 9600 2300 RC Leiden, The Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: Creutzberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D003657:Decision Making; D016889:Endometrial Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010358:Patient Participation; D057240:Patient Preference; D010817:Physician-Patient Relations; D010820:Physicians; D011795:Surveys and Questionnaires