http://www.sciencedirect.

com/science/article/pii/S0277953605001802

Information giving and decision-making in patients with

advanced cancer: A systematic review
Christine M. Gaston. Author links open the author workspace.Opens the author
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these in author workspace
Geoffrey Mitchell. Author links open the author workspace.b. Numbers and
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Cornford House Surgery, 364 Cherry Hinton Road, Cambridge CB2 4PH, UK

Discipline of General Practice, University of Queensland, Brisbane, Australia

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https://doi.org/10.1016/j.socscimed.2005.04.015Get rights and content

Abstract
Patients with advanced, non-curable cancer face difficult decisions on
further treatment, where a small increase in survival time must be
balanced against the toxicity of the treatment. If patients want to be
involved in these decisions, in keeping with current notions of
autonomy and empowerment, they also require to be adequately
informed both on the treatments proposed and on their own disease
status and prognosis.

A systematic review was performed on decision-making and

information provision in patients with advanced cancer. Studies of
interventions to improve information giving and encourage participation
in decision-making were reviewed, including both randomised
controlled trials and uncontrolled studies. Almost all patients expressed
a desire for full information, but only about two-thirds wished to
participate actively in decision-making. Higher educational level,
younger age and female sex were predictive of a desire to participate
in decision-making. Active decision-making was more common in
patients with certain cancers (e.g. breast) than others (e.g. prostate). A
number of simple interventions including question prompt sheets,
audio-taping of consultations and patient decision aids have been
shown to facilitate such involvement.

http://www.sciencedirect.com/science/article/pii/S0959804908006813

Communicating cancer diagnosis and prognosis:

When the target is the elderly patient-a GIOGer study
Lazzaro Repetto. Author links open the author workspace.Opens the author
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these in author workspace
Pierluca Piselli. Author links open the author workspace.b. Numbers and letters
correspond to the affiliation list. Click to expose these in author workspace
Mimma Raffaele. Author links open the
a. Numbers and letters correspond to the affiliation list. Click to expose these in author workspace
author workspace. Carola
c. Numbers and letters correspond to the affiliation list.
Locatelli. Author links open the author workspace.
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for the GIOGer. Author links open the author workspace.cd.
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Istituto Nazionale di Riposo e Cura per Anziani (INRCA), U.O. Oncologia, Via
Cassia 1167, 189 Rome, Italy

Istituto L. Spallanzani, Rome, Italy

UO Oncologia, INRCA, Rome, Italy

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https://doi.org/10.1016/j.ejca.2008.08.020Get rights and content

Abstract
Background
Effective communication to cancer patients allows better emotional
response to diagnosis, coping with health professionals and
compliance to treatment. We lack specific studies on patterns of
clinical communication in elderly patients, their involvement in decision
making and the role of their families.

Patients and methods

Structured interviews to collect information on diagnosis and prognosis
disclosure, satisfaction with information, compliance to disease
experience and willingness toward receiving more information and
coping, were administered to patients age 65 years and older and
receiving chemotherapy.

Results
Six hundred and twenty two patients completed the interviews and
were evaluated. Four hundred and twelve (66.2%) were informed, 210
(33.8%) were not informed.

Information was associated with age, degree of education,

geographical area, ECOG-PS, tumour site and family composition and
the patient’s perception of being supported in the disease experience.

The majority of the patients consider their families as the main source
of support in the disease experience (86.5%), wish to have a family
member participating in oncology consultation (79.1%) and consider
the information received complete and understandable or clear and
reassuring (80%). Receiving adequate information facilitates a better
patient–health professional relationship for 84.8% of the patients. 63%
of the patients dealt positively with cancer and 62.2% showed positive
expectations for the future. Informed patients refer better expectation
than those not informed.

Conclusion
Our study underlines the importance of clinical information for older
cancer patients and the need to involve family members in the
processes of diagnosis and prognosis disclosure and decision making.

Health professionals must consider specific age-related issues

including social, cultural and emotional aspects and understand the
role that the family members play in the disease experience of elderly
patients.

Competent caring for elderly cancer patients must provide adequate

information and emotional support not only to the patients but also to
their family to assure appropriateness of care.

Keywords
Communication

Diagnosis and prognosis disclosure

Elderly patient

Cancer in the elderly

http://ascopubs.org/doi/full/10.1200/JCO.2001.19.11.2883

Patient Preferences Versus Physician

Perceptions of Treatment Decisions in Cancer
Care
Eduardo Bruera, Catherine Sweeney, Kathryn Calder, Lynn Palmer, Suzanne
Benisch-TolleyShow More
https://doi.org/10.1200/JCO.2001.19.11.2883

Abstract

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 prospectively studied in 78 assessable cancer patients after initial
assessment at a palliative care outpatient clinic. DMPs were assessed with a
questionnaire using five possible choices ranging from 1 (patient prefers to
make the treatment decision) to 5 (patient prefers the physician to make the
decision). In addition, the physician’s perception of this preference was
assessed.

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 was concordance in 35
(45%) of 78 cases. The kappa coefficient for agreement between physician 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 weighted kappa
(calculated on the three regrouped categories). Active, shared, 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 predicted 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

assessed prospectively for DMP.

http://ascopubs.org/doi/pdf/10.1200/JCO.2002.20.2.503

When the Treatment Goal Is Not Cure: Are Cancer

Patients Equipped to Make Informed Decisions?
Melina Gattellari, Katie J. Voigt, Phyllis N. Butow, Martin H.N. TattersallShow More
https://doi.org/10.1200/JCO.2002.20.2.503

Abstract

PURPOSE: Informed decision making now is considered the underpinning of

ethical medical practice. We aimed to determine the extent to which patients
with incurable cancer are adequately informed of their prognosis and treatment
options and encouraged to participate in treatment decisions.

PATIENTS AND METHODS: One hundred eighteen cancer patients with

incurable disease presenting for an initial consultation with one of nine
oncologists at two Sydney tertiary referral hospitals participated in the study.
Consultations were recorded on audiotape to permit a content analysis of
doctor-patient interactions. We devised a coding system to assess disclosure of
information and to evaluate doctor encouragement of patient participation in
treatment decision making. Patient recall, satisfaction, anxiety, and perceptions
of the decision-making process were assessed to determine the effects of
informed decision making on patient outcomes.

RESULTS: Most patients were informed about the aim of anticancer treatment
(84.7%), that their disease was incurable (74.6%), and about life expectancy
(57.6%). An alternative to anticancer treatments was presented to 44.1%, 36.4%
were informed about how anticancer treatment would affect quality of life, and
29.7% were offered a management choice. Oncologists checked patient
understanding in only 10.2% of consultations. Although greater information
disclosure did not seem to elevate anxiety levels, greater patient participation in
the decision-making process was associated with increased anxiety levels (P =
.0005), which persisted over a 2-week time span.
CONCLUSION: Most patients were well informed, but important gaps remain,
especially concerning information about prognosis and alternatives to
anticancer treatment. These gaps invite the question concerning whether
patients are led toward anticancer treatment.

http://ascopubs.org/doi/pdf/10.1200/JCO.2002.20.2.503