title: The choice dilemma in chronic hematological conditions: Why choosing is not only a medical issue? A psycho-cognitive perspective.
abstract: Research in cognitive psychology focused on risk perception and decision making was shown to facilitate treatment choice and patient's satisfaction with decision in a number of medical conditions, increasing perceived alliance between patient and physician, and adherence to treatment. However, this aspect has been mostly neglected in the literature investigating choice of treatment for chronic hematological conditions. In this paper, a patient centered model and a shared decision making (SDM) approach to treatment switch in chronic hematological conditions, in particular chronic myeloid leukemia, atrial fibrillation, and β-thalassemia is proposed. These pathologies have a series of implications requiring important decisions about new available treatments. Although new generation treatments may provide a significant improvement in patient's health and health-related quality of life (HrQoL), a significant percentage of them is uncertain about or refuse treatment switch, even when strongly suggested by healthcare guidelines. Possible cognitive and emotional factors which may influence decision making in this field and may prevent appropriate risk-and-benefits evaluation of new treatment approaches are reviewed. Possible adaptive strategies to improve quality of care, patient participation, adherence to treatment and final satisfaction are proposed, and implications relatively to new treatment options available are discussed.
authors.affiliation: Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Renzi
authors.affiliation: Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy. Electronic address: silvia.riva1@unimi.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Riva
authors.affiliation: Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Masiero
authors.affiliation: Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pravettoni
mesh_terms: D002755:Choice Behavior; D002908:Chronic Disease; D003071:Cognition; D003657:Decision Making; D006402:Hematologic Diseases / Q000517:prevention & control* / Q000523:psychology*; D006801:Humans; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians; D011788:Quality of Life
keywords: Atrial fibrillation; Chronic myeloid leukemia; Decision making; Patients’ decision; Treatment switch; β-Thalassemia