title: Decision consultations on preoperative radiotherapy for rectal cancer: large variation in benefits and harms that are addressed.
abstract: BACKGROUND
  For shared decision making to be successful, patients should receive sufficient information on possible benefits and harms of treatment options. The aim of this study was to evaluate what information radiation oncologists provide during the decision consultation about preoperative radiotherapy with rectal cancer patients.
  
  
  METHODS
  Decision consultations of 17 radiation oncologists with 81 consecutive primary rectal cancer patients, eligible for short-course radiotherapy followed by a low-anterior resection, were audio taped. Tapes were transcribed and analysed using the ACEPP (Assessing Communication about Evidence and Patient Preferences) coding scheme.
  
  
  RESULTS
  A median of seven benefits/harms were addressed per consultation (range, 2-13). This number ranged within and between oncologists and was not clearly associated with the patient's characteristics. A total of 30 different treatment outcomes were addressed. The effect of radiotherapy on local control was addressed in all consultations, the effect on survival in 16%. The most important adverse effects are bowel and sexual dysfunction. These were addressed in 82% and 85% of consultations, respectively; the latter significantly less often in female than in male patients. Four out of five patients did not initiate discussion on any benefits/harms.
  
  
  CONCLUSIONS
  Our results showed considerable inconsistency between and within oncologists in information provision, which could not be explained by patient characteristics. This variation indicates a lack of clarity on which benefits/harms of radiotherapy should be discussed with newly-diagnosed patients. This suboptimal patient information hampers the process of shared decision making, in which the decision is based on each individual patients' weighing of benefits and harms.
authors.affiliation: Leiden University Medical Center, Department of Medical Decision Making, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kunneman
authors.affiliation: Leiden University Medical Center, Department of Clinical Oncology, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: C A M
authors.initials: CA
authors.lastname: Marijnen
authors.affiliation: Verbeeten Institute, PO Box 90120, 5000 LA Tilburg, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Rozema
authors.affiliation: Radiotherapy Center West, Medical Center Haaglanden, PO Box 432, 2501 CK The Hague, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: Ceha
authors.affiliation: Reinier de Graaf Group, Department of Radiotherapy, PO Box 5011, 2600 GA Delft, The Netherlands.
authors.forename: D A R H
authors.initials: DA
authors.lastname: Grootenboers
authors.affiliation: Leiden University Medical Center, Department of Clinical Oncology, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: K J
authors.initials: KJ
authors.lastname: Neelis
authors.affiliation: Leiden University Medical Center, Department of Medical Decision Making, PO 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 Medical Decision Making, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: Pieterse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012004:Rectal Neoplasms / Q000532:radiotherapy*; D012017:Referral and Consultation; D016896:Treatment Outcome