Reporter: Jacob E. Shabason, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 4, 2013
Presenter: Jacob E. Shabason, MD
Presenter’s Affiliation: University of Pennsylvania Department of Radiation Oncology, Philadelphia, PA
Shared decision making (SDM) is a process where both a physician and a patient share information about a disease, discuss its actual and potential effects on the patient, review the medically appropriate treatment options, and then ultimately reach a consensus regarding the most appropriate treatment approach for that specific patient. This form of decision-making is a significant departure away from the paternalism traditionally associated with the physician patient relationship, and is important for patient-centered care and establishing a meaningful and therapeutic physician-patient relationship.
In a variety of medical fields, SDM is associated with important patient outcomes including satisfaction. However, the value of SDM has not been thoroughly evaluated in radiation oncology. As such, the authors performed a cross-sectional patient survey at an urban academic radiation oncology center to better evaluate the prevalence of SDM and perception of control in treatment decisions and assess their impact on patient satisfaction and well-being.
A total of 305 diverse patients with a variety of cancers at different stages completed the survey during the last week of radiation therapy. Overall, 31.3% of patients reported experiencing SDM, 32.1% perceived control in their treatment decisions and 76.3% were very satisfied with their radiation treatments. Patient satisfaction correlated both with SDM (84.4% vs.71.4%, p<0.02) and perception of control in treatment decisions (89.7% vs.69.2%, p<0.001). Importantly, the perception of control was associated with an increase in satisfaction regardless of whether patients desired control or simply preferred a more passive roll in treatment decision. Lastly, patients who specifically desired, but did not perceive control in treatment decisions experienced more anxiety (44.0% vs. 20.0%, p <0.02), depression (44.0% vs. 15.0%, p <0.01) and fatigue (68.0% vs. 32.9%, p <0.01) as compared to those who did perceive control.
Overall, this study highlights the importance of SDM and patient–perceived control in radiation oncology, particularly as it relates to satisfaction, anxiety, depression and fatigue. It is vital for radiation oncologists to actively engage all patients in treatment decisions, even patients who may express no desire to be involved in treatment decisions. With only approximately one third of patients experiencing SDM, there is certainly room for improvement in engaging patients in the decision making process. In the complicated field of radiation oncology, physician and patient targeted interventions may help improve the shared decision making process and thereby improve patient satisfaction and well-being.