Patient preferences versus physician perceptions of treatment decisions incancer care

Purpose: To examine patient preferences as well as physician perceptions of these preferences for decision making and communication in palliative care . Patients and Methods: Medical decision-making preferences (DMPs) were prosp ectively studied in 78 assessable cancer patients after initial assessment at a palliative care outpatient clinic. DMPs were assessed with a questionn aire using five possible choices ranging from 1 (patient prefers to make th e treatment decision) to 5 (patient prefers the physician to make the decis ion). In addition, the physician's perception of this preference was assess ed. Results: Full concordance between the physician and the patient was seen in 30 (38%) of 78 cases; when the five original categories were recombined to cover active, shared, and passive decision making, there wets concordance in 35 (45%) of 78 cases. The kappa coefficient for agreement between physic ian and patient was poor at 0.14 (95% confidence limit, -0.01 to 0.30) for simple kappa and 0.17 (95% confidence interval [CI], 0.00 to 0.34) for weig hted kappa (calculated on the three regrouped categories). Active, shored, and passive DMPs were chosen by 16 (20%) of 78, 49 (63%) of 78, and 13 (17% ) of 78 patients, and by 23 (29%) of 78, 30 (39%) of 78, and 25 (32%) of 78 physicians, respectively. The majority of patients (49 [63%] of 78; 95% CI , 0.51 to 0.74) preferred a shared approach with physicians. Physicians pre dicted that patients preferred a less shared approach than they in fact did . Patient age or sex did not significantly alter DMP, Conclusion: An individual approach is needed and each patient should be ass essed prospectively for DMP.