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Patients' views on decision making in advanced cancer

Published online by Cambridge University Press:  18 June 2009

Jennifer Philip*
Affiliation:
Centre for Palliative Care Education and Research, St. Vincent's Hospital, Fitzroy, Victoria, Australia
Michelle Gold
Affiliation:
Palliative Care Service, The Alfred Hospital, Melbourne, Victoria, Australia
Max Schwarz
Affiliation:
Medical Oncology Service, The Alfred Hospital, Melbourne, Victoria, Australia
Paul Komesaroff
Affiliation:
Centre for the Study of Ethics in Medicine and Society, Department of Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
*
Address correspondence and reprint requests to: Jennifer Philip, Centre for Palliative Care Education and Research, St. Vincent's Hospital, PO Box 2900, Fitzroy, Vic. 3065, Australia. E-mail: jennifer.philip@svhm.org.au

Abstract

Objective:

To explore patients' understanding of decision making in the treatment of advanced cancer and to determine the factors they believe important to these processes in their care.

Methods:

Surveys were distributed to consecutive outpatients with advanced malignancy attending a comprehensive cancer treatment center.

Results:

Patients believed that the medical condition (94%), their doctors' experience (81%), and the medical literature (73%) are the most important factors for decisions made in their care. They also value their relationship with the doctor (63%) and their own (the patients') values (63%), and just over a third considered their family's values and the doctors' personality important. Most did not believe the doctors' values should influence decisions made. They were mindful of the uncertainty involved in decisions in the setting of advanced cancer.

Significance of results:

Overall, patients were satisfied with the decision-making processes and they understood and highly regarded the incorporation of factors, other than their medical condition, in their care.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

Asch, D.A. & Christakis, N.A. (1996). Why do physicians prefer to withdraw some forms of life support over others? Intrinsic attributes of life-sustaining treatments associated with physicians' preferences. Medical Care, 34, 103111.CrossRefGoogle ScholarPubMed
Bidmead, C. & Cowley, S. (2005). A concept analysis of partnership with clients. Community Practice, 78, 203208.Google ScholarPubMed
Burns, C.M., Dixon, T., Smith, W.T., et al. (2004). Patients with advanced cancer and family caregivers' knowledge of health. Health and Social Care in the Community, 12, 488503.Google Scholar
Cook, D.J., Guyatt, G.H., Jaeschke, R., et al. (1995). Determinants in Canadian health care workers of the decision to withdraw life support from the critically ill. JAMA, 273, 703708.CrossRefGoogle ScholarPubMed
Davison, B.J. & Degner, L.F. (1998). Promoting patient decision making in life-and-death situations. Seminars in Oncology Nursing, 14, 129136.CrossRefGoogle ScholarPubMed
de Haes, H. & Koedoot, N. (2003). Patient centred decision making in palliative cancer treatment: A world of paradoxes. Patient Education and Counseling, 50, 4349.CrossRefGoogle Scholar
Drought, T.S. & Koenig, B. (2003). Choice in end of life. The Gerontologist, 42, 114128.CrossRefGoogle Scholar
Eisemann, M., Eriksson, M., Molloy, D.W., et al. (1999). Attitudes towards self-determination in health care: A general population survey in northern Sweden. European Journal of Public Health, 9, 4144.CrossRefGoogle Scholar
Harkness, J. (2005). Patient involvement: A vital principle for patient-centred health care. World Hospitals and Health Services, 41, 1216.Google Scholar
Henman, M.J., Butow, P., Brown, R.F., et al. (2002). Lay constructions of decision-making in cancer. Psycho-Oncology, 11, 295306.CrossRefGoogle ScholarPubMed
Hilden, H.M., Louiala, P. & Palo, J. (2004). End of life decisions: Attitudes of Finnish physicians. Journal of Medical Ethics, 30, 362365.CrossRefGoogle ScholarPubMed
Kite, S. & Tate, T. (2005). Choice and palliative care: What do we mean? Palliative Medicine, 19, 267269.CrossRefGoogle ScholarPubMed
Komesaroff, P. (1995). From bioethics to microethics; ethical debate and clinical medicine. In Troubled bodies, Komesaroff, P. (ed.), pp. 6286. Melbourne: Melbourne University Press.Google Scholar
Miner, T.S. (2005). Palliative surgery for advanced cancer: Lessons learned in patient selection and outcome assessment. American Journal of Clinical Oncology, 28, 411414.CrossRefGoogle ScholarPubMed
Rothenbacher, D., Lutz, M.P. & Porzsolt, F. (1997). Treatment decisions in palliative cancer care: Patients' preferences for involvement and doctors' knowledge about it. European Journal of Cancer, 33, 11841189.Google Scholar
Sainio, C., Lauri, S. & Eriksson, E. (2001). Cancer patients' views and experiences of participation in care and decision making. Nursing Ethics, 8, 97113.CrossRefGoogle ScholarPubMed
Shah, S. & Lloyd-Williams, M. (2003). End-of-life decision making: Have we got it right? European Journal of Cancer Care, 12, 212214.CrossRefGoogle ScholarPubMed
Shen, J., Andersen, R., Brook, R., et al. (2004). The effects of payment method on clinical decision making: Physician responses to clinical scenarios. Medical Care, 42, 297302.CrossRefGoogle ScholarPubMed
Steinhauser, K.E., Clipp, E.C., McNeilly, M., et al. (2000). In search of a good death: Observations of patients, families and providers. Annals of Internal Medicine, 132, 825832.CrossRefGoogle ScholarPubMed
Sullivan, K.E., Hebert, P.C., Logan, J., et al. (1996). What do physicians tell patients with end-stage COPD about intubation and mechanical ventilation? Chest, 109, 264.CrossRefGoogle ScholarPubMed
Woolf, S.H., Chan, E.C.Y., Harris, R., et al. (2005). Promoting informed choice: Transforming health care to dispense knowledge for decision making. Annals of Internal Medicine, 143, 293300.Google Scholar