Sharing decisions in cancer care

Previous studies have demonstrated that the majority of cancer patients fai l to achieve their desired level of participation during treatment decision making. However, it is unclear whether this failure affects patient well-b eing and satisfaction. Furthermore, whilst shared decision making is curren tly espoused as the preferred model for doctor-patient relations, little em pirical evidence exists showing it has beneficial effects for patients. We aimed to evaluate the impact of shared decision making and the achievement of preferred role on patient anxiety, recall of information, and satisfacti on, Patients with cancer indicated their preferred level of participation i n decision making and preferences for information and emotional support pri or to their initial consultation with an oncologist. Anxiety was assessed p rior to and immediately after the consultation and recall seven days after the consultation. Anxiety was reassessed at two-weeks post-consultation at which time patients also reported their satisfaction with the consultation and perceived role of participation in treatment decision making. Satisfact ion with the information and emotional support received was also evaluated. Of the 233 patients available for analysis, a match between preferred and p erceived roles was found for over one-third of patients (34%), with 29% mor e active and 37% less involved in decision making than preferred. Multivari ate analyses demonstrated that role mismatch significantly predicted change s in anxiety levels from pre to immediate post-consultation (p = 0.03). How ever, irrespective of preferred role in decision making, perceived role, bu t not role mismatch, significantly and independently predicted satisfaction with both the consultation (p = 0.0005) and the amount of information and emotional support received from the doctor (p = 0.004). Patients who report ed a shared role in decision making were most satisfied with the consultati on and with the information about treatment and emotional support received. Those who reported that either themselves or the doctor exclusively made t he decision were least satisfied. These findings underscore the pre-eminenc e of the shared decision making model and suggest that encouraging particip ation may be the safest standard approach. Doctor - as well as patient - ba sed interventions are required to promote patient participation. (C) 2001 E lsevier Science Ltd. All rights reserved.