Patient participation in medical decision-making: A French study in adjuvant radio-chemotherapy for early breast cancer

Background: Shared decision-making is increasingly advocated as an ideal mo del. However, very few studies have tested the feasibility of giving patien ts the opportunity to participate in the choice of treatment. Patients and methods: Women, with non-metastatic breast cancer, eligible fo r non-intensified adjuvant chemotherapy attending our hospital were propose d two administrations of chemotherapy and radiotherapy: a sequential and a concomitant one. Two patient-questionnaires were used to elicit motivations for their choice and their degree of comfort with the process of decision- making and one questionnaire to test physicians' ability to predict patient s' choice. Results: Participation rate in the study was 75.3% (n = 64). Majority (64%) of patients chose the concomitant treatment. Multivariate analysis reveale d that patients with a lower level of education, who discussed the choice w ith social circle, and who most feared side-effects were more likely to cho ose the sequential treatment. Physicians were able to predict patients' cho ice in 66% of cases. 89% of patients declared that they were "fully satisfi ed" with having participated in the choice of treatment and 79% supported s hared decision-making. Conclusions: Results are in favour of promoting active participation of can cer-patients in medical decision-making. The adequate degree of such partic ipation remains however to be elicited and tested for therapeutic choices i mplying more difficult trade-offs between quantity and quality of life.