Patients often lead when evidence of benefit is uncertain; doctors lead when there is no evidence-- Jeff Muise
Monday, August 16, 2010 (Last Updated: 08/17/2010)
MONDAY, Aug. 16 (HealthDay News) -- Cancer patients tend to participate in treatment decision-making more when evidence of benefit is uncertain, but leave treatment decisions to physicians in cases where there is no evidence at all to support treatment benefits, according to research published online Aug. 16 in the Journal of Clinical Oncology.
Nancy L. Keating, M.D., of Harvard Medical School in Boston, and colleagues studied the responses of 5,383 patients with recently diagnosed lung or colorectal cancer surveyed about their roles in decision-making regarding surgery, chemotherapy, and/or radiation therapy. The researchers analyzed 10,939 decisions to assess whether characteristics of the decision (expected benefit, patient preference, treatment modality) influenced patients' roles in decision-making.
The researchers found that 38.9 percent of the decisions were controlled by the patient, 43.6 percent were shared decisions, and 17.5 percent were controlled by physicians. When the evidence supporting a treatment was uncertain, patient control was greatest, while physician control was greatest when there was no evidence for or against a treatment. When there was good evidence to support a treatment, shared control was greatest. Physicians tended to control decisions about metastatic cancer treatment more so than other treatment decisions.
"Patients making decisions about treatments for which no evidence supports benefit and decisions about non-curative treatments reported more physician control, which suggests that patients may not want the responsibility of deciding on treatments that will not cure them," the authors write.
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