Shared decision-making and patient control in radiation oncology: Implications for patient satisfaction

Authors

  • Jacob E. Shabason MD,

    1. Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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  • Jun J. Mao MD, MSCE,

    1. Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania
    2. Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania
    3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Eitan S. Frankel BA,

    1. Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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  • Neha Vapiwala MD

    Corresponding author
    1. Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
    2. Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania
    • Corresponding author: Neha Vapiwala, MD, Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, 4th Fl West Pavilion, Philadelphia, Pennsylvania 19104; Fax: (215) 349-8975; vapiwala@uphs.upenn.edu

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Abstract

BACKGROUND

Shared decision-making (SDM) has been linked to important health care quality outcomes. However, to the authors' knowledge, the value of SDM has not been thoroughly evaluated in the field of radiation oncology. The objective of the current study was to determine the association between SDM and patient satisfaction during radiotherapy (RT). The authors also explored patient desire for and perception of control during RT, and how these factors relate to patient satisfaction, anxiety, depression, and fatigue.

METHODS

A cross-sectional survey of 305 patients undergoing definitive RT was conducted. Patients self-reported measured variables during the last week of RT. Relationships between variables were evaluated using chi-square analyses.

RESULTS

Among study participants, 31.3% of patients experienced SDM, 32.3% perceived control in treatment decisions, and 76.2% reported feeling very satisfied with their care. Patient satisfaction was associated with perceived SDM (84.4% vs 71.4%; P < .02) and patient-perceived control (89.7% vs 69.2%; P < .001). Furthermore, the perception of having control in treatment decisions was associated with increased satisfaction regardless of whether the patient desired control. Increased anxiety (44.0% vs 20.0%; P < .02), depression (44.0% vs 15.0%; P < .01), and fatigue (68.0% vs 32.9%; P < .01) were reported in patients who desired but did not perceive control over their treatments, compared with those who both desired and perceived control.

CONCLUSIONS

The findings of the current study emphasize the value of SDM and patient-perceived control during RT, particularly as it relates to patient satisfaction and psychological distress. Regardless of a patient's desire for control, it is important to engage patients in the decision-making process. Cancer 2014;120:1863–1870. © 2014 American Cancer Society.

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