title: Expected survival with and without second-line palliative chemotherapy: who wants to know?
abstract: BACKGROUND
  According to surveys, many patients with advanced cancer wish to receive survival information.
  
  
  OBJECTIVE
  This study investigated information preferences by offering patients a decision aid (DA) with information on expected survival for two treatment options: supportive care with or without second-line palliative chemotherapy. Predictors of accepting survival information were explored.
  
  
  METHODS
  Eligible patients in this multicentre prospective study were offered second-line chemotherapy for advanced breast or colorectal cancer. A nurse presented a DA on second-line treatment and asked patients whether they desired information on (i) adverse events, (ii) tumour response and (iii) survival. Data on 50 clinical and psychosocial patient characteristics were collected from inclusion forms and patient questionnaires.
  
  
  RESULTS
  Seventy-seven patients received a DA; median age 62 years (range 32-80), 61% female, 77% colorectal cancer. Fifty-seven patients (74%; 95% CI 64-84) desired survival information. Four psychosocial characteristics (e.g. deliberative decision style) independently predicted information desire. However, the use of these characteristics to predict information desire hardly outperformed a simple prediction rule.
  
  
  CONCLUSIONS
  Many patients desired information on expected survival when deciding about second-line treatment. However, our exploratory analysis indicated that patients desiring this information could not be identified based on their clinical or psychosocial characteristics. These findings can help encourage candid discussions about expected survival. Health professionals should be careful not to make implicit assumptions of information desire based on patient characteristics, but to explicitly ask patients if survival information is desired, and act accordingly.
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Linda J M
authors.initials: LJ
authors.lastname: Oostendorp
authors.affiliation: Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Petronella B
authors.initials: PB
authors.lastname: Ottevanger
authors.affiliation: Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands.
authors.forename: Agnes J
authors.initials: AJ
authors.lastname: van de Wouw
authors.affiliation: Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Ivonne J H
authors.initials: IJ
authors.lastname: Schoenaker
authors.affiliation: Leeuwarden Oncology Centre, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Hiltje
authors.initials: H
authors.lastname: de Graaf
authors.affiliation: Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Winette T A
authors.initials: WT
authors.lastname: van der Graaf
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Peep F M
authors.initials: PF
authors.lastname: Stalmeier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D011446:Prospective Studies; D011584:Psychology
keywords: decision aids; information desire; palliative chemotherapy; predictors; survival information; treatment decision