title: Was a decision made? An assessment of patient-clinician discordance in medical oncology encounters.
abstract: BACKGROUND
  Shared decision making is promoted to improve cancer care quality. Patients and clinicians may have different ideas about what constitutes a cancer care decision, which may limit the validity of self-reported measures of shared decision making. We sought to estimate the extent to which patients and clinicians agree on whether a cancer care decision was made during an outpatient encounter.
  
  
  METHODS
  We surveyed patients and clinicians immediately after an oncology encounter at a large, tertiary medical centre and calculated agreement in response to the single-item question, 'Was a specific decision about cancer care made during the appointment today?' Answer options were 'yes' and 'no'. Participants were 315 oncology patients, with any solid tumour malignancy and at any stage of management, and their clinicians (22 staff oncologists, nine senior fellows and five nurse practitioners).
  
  
  RESULTS
  Patients and clinicians reported having made a cancer care decision in 184 (58%) and 174 (55%) of encounters, respectively. They agreed on whether a cancer care decision was made in 213 (68%) of encounters (chance-adjusted agreement was 0.34); in 56 of the 102 discordant encounters, the patient reported making a decision while the clinician did not. We found no significant correlates with discordance.
  
  
  CONCLUSIONS
  Patients and clinicians do not always agree on whether a cancer care decision was made. As such, measures that ask patients and/or clinicians to evaluate a decision-making process or outcome may be methodologically insufficient when they do not explicitly orient respondents towards the thing they are being asked to assess.
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Leppin
authors.affiliation: Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Humeniuk
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Fernandez
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Yost
authors.affiliation: Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumbamu
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.|Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Geller
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.|Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.|Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010358:Patient Participation; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires
keywords: cancer communication; discordance; medical decisions; shared decision making