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A survey of cancer patients has shown that when physicians make treatment decisions alone, patients tend to rate the quality of care lower than when physicians include patients in the decision-making process.
Researchers found this to be the case even among patients who said they preferred it when physicians made treatment decisions alone.
Kenneth L. Kehl, MD, of MD Anderson Cancer Center in Houston, Texas, and his colleagues reported these findings in JAMA Oncology.
The researchers surveyed 5315 cancer patients who reported decision roles for 10,817 treatment decisions. The team assessed the association between patients’ roles in decisions with their reports on quality of care and physician communication.
Most of the patients (58%) said they preferred shared roles in decision-making, 36% preferred patient-controlled decisions, and 6% preferred physician-controlled decisions.
The patients reported that their actual decision-making process was patient-controlled in 39% of decisions, shared in 44%, and physician-controlled in 17%. Of the treatment decisions made by patients, 42% were regarding surgery, 36% were regarding chemotherapy, and 22% were regarding radiation.
The researchers found that patients’ preferred role in decision-making was not associated with how they rated the quality of care. But when they reported that treatment decisions were controlled by physicians, the patients were less likely to rate the quality of care as excellent, as compared to shared-decision making situations.
Patients said physician care was excellent in 67.8% of cases. And 55.8% of patients gave their physicians the highest possible rating of communication.
However, patients who preferred physician-controlled decisions to shared decision-making were less likely to give top ratings to their physicians, as were patients who reported actually experiencing physician-controlled vs shared decisions.
The researchers said these results highlight the benefits of promoting shared decision-making among all patients with cancer, even those who seem to prefer less active roles in the process.
In a related commentary, Sarah T. Hawley, PhD, and Reshma Jagsi, MD, DPhil, of the University of Michigan in Ann Arbor, said they were intrigued by the fact that the association between shared decision-making and patient appraisal of care quality remained even when controlling for a patient’s preferred role in the decision-making process.
“Kehl and colleagues conclude from this finding that it is important to promote [shared decision-making], even among patients who may seek less active roles,” Drs Hawley and Jagsi wrote.
“Yet . . . prior work . . . has suggested that it is the match between patients’ preferred and actual involvement that contributes to greater satisfaction with care. These conflicting results underscore the need for further work to better quantify and link measures of [shared decision-making] to patient appraisal of care.” 
Photo by Rhoda Baer
A survey of cancer patients has shown that when physicians make treatment decisions alone, patients tend to rate the quality of care lower than when physicians include patients in the decision-making process.
Researchers found this to be the case even among patients who said they preferred it when physicians made treatment decisions alone.
Kenneth L. Kehl, MD, of MD Anderson Cancer Center in Houston, Texas, and his colleagues reported these findings in JAMA Oncology.
The researchers surveyed 5315 cancer patients who reported decision roles for 10,817 treatment decisions. The team assessed the association between patients’ roles in decisions with their reports on quality of care and physician communication.
Most of the patients (58%) said they preferred shared roles in decision-making, 36% preferred patient-controlled decisions, and 6% preferred physician-controlled decisions.
The patients reported that their actual decision-making process was patient-controlled in 39% of decisions, shared in 44%, and physician-controlled in 17%. Of the treatment decisions made by patients, 42% were regarding surgery, 36% were regarding chemotherapy, and 22% were regarding radiation.
The researchers found that patients’ preferred role in decision-making was not associated with how they rated the quality of care. But when they reported that treatment decisions were controlled by physicians, the patients were less likely to rate the quality of care as excellent, as compared to shared-decision making situations.
Patients said physician care was excellent in 67.8% of cases. And 55.8% of patients gave their physicians the highest possible rating of communication.
However, patients who preferred physician-controlled decisions to shared decision-making were less likely to give top ratings to their physicians, as were patients who reported actually experiencing physician-controlled vs shared decisions.
The researchers said these results highlight the benefits of promoting shared decision-making among all patients with cancer, even those who seem to prefer less active roles in the process.
In a related commentary, Sarah T. Hawley, PhD, and Reshma Jagsi, MD, DPhil, of the University of Michigan in Ann Arbor, said they were intrigued by the fact that the association between shared decision-making and patient appraisal of care quality remained even when controlling for a patient’s preferred role in the decision-making process.
“Kehl and colleagues conclude from this finding that it is important to promote [shared decision-making], even among patients who may seek less active roles,” Drs Hawley and Jagsi wrote.
“Yet . . . prior work . . . has suggested that it is the match between patients’ preferred and actual involvement that contributes to greater satisfaction with care. These conflicting results underscore the need for further work to better quantify and link measures of [shared decision-making] to patient appraisal of care.”
Photo by Rhoda Baer
A survey of cancer patients has shown that when physicians make treatment decisions alone, patients tend to rate the quality of care lower than when physicians include patients in the decision-making process.
Researchers found this to be the case even among patients who said they preferred it when physicians made treatment decisions alone.
Kenneth L. Kehl, MD, of MD Anderson Cancer Center in Houston, Texas, and his colleagues reported these findings in JAMA Oncology.
The researchers surveyed 5315 cancer patients who reported decision roles for 10,817 treatment decisions. The team assessed the association between patients’ roles in decisions with their reports on quality of care and physician communication.
Most of the patients (58%) said they preferred shared roles in decision-making, 36% preferred patient-controlled decisions, and 6% preferred physician-controlled decisions.
The patients reported that their actual decision-making process was patient-controlled in 39% of decisions, shared in 44%, and physician-controlled in 17%. Of the treatment decisions made by patients, 42% were regarding surgery, 36% were regarding chemotherapy, and 22% were regarding radiation.
The researchers found that patients’ preferred role in decision-making was not associated with how they rated the quality of care. But when they reported that treatment decisions were controlled by physicians, the patients were less likely to rate the quality of care as excellent, as compared to shared-decision making situations.
Patients said physician care was excellent in 67.8% of cases. And 55.8% of patients gave their physicians the highest possible rating of communication.
However, patients who preferred physician-controlled decisions to shared decision-making were less likely to give top ratings to their physicians, as were patients who reported actually experiencing physician-controlled vs shared decisions.
The researchers said these results highlight the benefits of promoting shared decision-making among all patients with cancer, even those who seem to prefer less active roles in the process.
In a related commentary, Sarah T. Hawley, PhD, and Reshma Jagsi, MD, DPhil, of the University of Michigan in Ann Arbor, said they were intrigued by the fact that the association between shared decision-making and patient appraisal of care quality remained even when controlling for a patient’s preferred role in the decision-making process.
“Kehl and colleagues conclude from this finding that it is important to promote [shared decision-making], even among patients who may seek less active roles,” Drs Hawley and Jagsi wrote.
“Yet . . . prior work . . . has suggested that it is the match between patients’ preferred and actual involvement that contributes to greater satisfaction with care. These conflicting results underscore the need for further work to better quantify and link measures of [shared decision-making] to patient appraisal of care.”