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Perception of Cancer Care Quality Higher When Patient Involved

But researchers still unclear as to whether shared decision-making results in better outcomes

THURSDAY, Feb. 12, 2015 (HealthDay News) — Cancer patients who let their doctors make all the decisions are less likely to rate their care as excellent compared to patients who participate in their medical decisions, a new study suggests. The report was published online Feb. 12 in JAMA Oncology.

Kenneth Kehl, M.D., an oncology fellow at the University of Texas MD Anderson Cancer Center in Houston, and colleagues collected data on 5,315 patients with lung cancer or colorectal cancer who took part in the Cancer Care Outcomes Research and Surveillance Consortium study. These patients reported their role in 10,817 treatment decisions, along with their perception of the quality of their care and how well they communicated with their doctors.

Most patients, 58 percent, said they preferred shared roles in decision-making, and 36 percent preferred patient-controlled decisions. Only 6 percent said they wanted their doctor to make all the decisions. Of the decisions made by patients, 42 percent were about surgery, 36 percent regarded chemotherapy, and 22 percent were about radiation therapy. Patients made 39 percent of actual decisions, and 44 percent were shared. However, 17 percent of decisions were made by doctors alone. In all, 67.8 percent of the patients said their care was excellent. Although patient preference for shared decision-making was not a factor in how they rated their care, those who let doctors make all the decisions were less likely to rate their care as excellent. In addition, 55.8 percent of patients gave their doctors the highest rating for doctor/patient communication. However, patients who preferred physician-controlled decision-making were less likely to give their doctor a high rating, as were patients who experienced physician-controlled versus shared decisions.

Reshma Jagsi, M.D., D.Phil., an associate professor of radiation oncology at the University of Michigan in Ann Arbor, and coauthor of an editorial that accompanied the study, told HealthDay: “These results are in contrast to prior work that suggested that it is the match between patients’ preferred and actual involvement that contributes to greater satisfaction with care,” she said. “These conflicting results underscore the need for further work to better quantify and link measures of shared decision-making to patient appraisal of care.”

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