Doctors' and patients' preferences for participation and treatment in curative prostate cancer radiotherapy.
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Publication year
2007Source
Journal of Clinical Oncology, 25, 21, (2007), pp. 3096-100ISSN
Publication type
Article / Letter to editor
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Organization
Health Evidence
Radiation Oncology
Former Organization
Epidemiology, Biostatistics & HTA
Journal title
Journal of Clinical Oncology
Volume
vol. 25
Issue
iss. 21
Page start
p. 3096
Page end
p. 100
Subject
NCEBP 2: Evaluation of complex medical interventions; ONCOL 3: Translational research; ONCOL 4: Quality of Care; UMCN 1.5: Interventional oncologyAbstract
PURPOSE: Physicians hold opinions about unvoiced patient preferences, so-called substitute preferences. We studied whether doctors can predict preferences of patients supported with a decision aid. METHODS: A total of 150 patients with prostate cancer facing radiotherapy were included. After the initial consultation, without discussing any treatment choice, physicians gave substitute judgments for patients' decision-making and radiation dose preferences. Physicians knew that several weeks later, patients would be empowered by a decision aid supporting a choice between two radiation doses involving a trade-off between disease-free survival and adverse effects. Subsequently, patient preferences for decision making (whether or not they wanted to choose a radiation dose) and for treatment (low or high dose) were obtained. The chosen radiation dose actually was administered. RESULTS: Of the patients studied, 79% chose a treatment; physicians believed that 66% of the patients wanted to choose. Agreement was poor (64%; = 0.13; P = .11), and was better as patients became more hopeful (odds ratio [OR] = 4.4 per unit; P = .001) and as physicians' experience increased (OR = 1.09 per year; P = .02). Twenty percent of physicians' preferences, 51% of physicians' substitute preferences, and 71% of patients' preferences favored the lower dose; agreement was again poor (70%; = 0.2; P = .03). CONCLUSION: Physicians had problems predicting the preferences of patients empowered with a decision aid. They slightly underestimated patients' decision-making preferences, and underestimated patients' preferences for the less toxic treatment. Counseling might be improved by first informing patients-possibly using a decision aid--before discussing patient preferences.
This item appears in the following Collection(s)
- Academic publications [238441]
- Electronic publications [122523]
- Faculty of Medical Sciences [90373]
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