title: Treatment recommendations by clinicians in stage I non-small cell lung cancer: A study of factors that influence the likelihood of accounting for the patient's preference.
abstract: Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with stage I non-small cell lung cancer (NSCLC). Shared decision making (SDM) has been advocated in this patient group. This study explored clinician decision making in relation to the stated treatment preferences of patients.
  
  
  
  In a previous study, we conducted a binary choice experiment with hypothetical cases among 126 clinicians. Secondary data analysis was performed using multilevel logistic regression models, in which random differences between clinicians' decisions were taken into account. We analyzed the influence of patient- and clinician-related characteristics, and uncertainty as experienced by clinicians about their recommendation on the clinician's decision (either in line with the patient's preference or not).
  
  
  
  Significant interactions were observed between patient- and clinician-related characteristics, indicating that patient preferences were selectively taken into account, depending on clinicians' specialty, their views about the comparability of cancer-related outcomes following surgery and SABR, and the degree of uncertainty about the treatment recommendation.
  
  
  
  Our findings suggest that SDM for stage I NSCLC care is largely influenced by how clinicians weigh available scientific evidence.
  
  
  
  Clinicians should involve lung cancer patients more and ask for their preferences in making treatment recommendations.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University medical center, Amsterdam, The Netherlands; Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands.
authors.forename: Wendy
authors.initials: W
authors.lastname: Hopmans
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University medical center, Amsterdam, The Netherlands.
authors.forename: Olga C
authors.initials: OC
authors.lastname: Damman
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University medical center, Amsterdam, The Netherlands.
authors.forename: Jarry T
authors.initials: JT
authors.lastname: Porsius
authors.affiliation: Institute of Medical Education Research Rotterdam, Erasmus MC, The Netherlands, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Zwaan
authors.affiliation: Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands.
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University medical center, Amsterdam, The Netherlands. Electronic address: drm.timmermans@vumc.nl.
authors.forename: Danielle R M
authors.initials: DR
authors.lastname: Timmermans
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D002755:Choice Behavior; D003657:Decision Making; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D010358:Patient Participation; D057240:Patient Preference; D010817:Physician-Patient Relations; D011013:Pneumonectomy; D016634:Radiosurgery; D035501:Uncertainty
keywords: Lung cancer; Patient preferences; Shared decision making; Treatment recommendations