TY - JOUR
T1 - Patient perspectives on treatment decision-making under clinical uncertainty
T2 - Chemotherapy treatment decisions among stage II colon cancer patients
AU - Brotzman, Laura E.
AU - Crookes, Danielle M.
AU - Austin, Jessica D.
AU - Neugut, Alfred I.
AU - Shelton, Rachel C.
N1 - Publisher Copyright:
© 2021 Society of Behavioral Medicine. All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - The decision to use adjuvant chemotherapy (ACT) after surgical resection for stage II colon cancer remains an area of clinical uncertainty. Many patients diagnosed with stage II colon cancer receive ACT, despite inconclusive evidence of long-term clinical benefit. This study investigates patient experiences and perceptions of treatment decision-making and shared decision making (SDM) for ACT among patients diagnosed with stage II colon cancer. Stage II colon cancer patients engaged in treatment or follow-up care aged >18 years were recruited from two large NYC health systems. Patients participated in 30-60-min semi-structured interviews. All interviews were transcribed, translated, coded, and analyzed using a thematic analysis approach. We interviewed 31 patients, of which 42% received ACT. Overall, patient perspectives indicate provider inconsistency in communicating ACT harms, benefits, and uncertainties, and poor elicitation of patient preferences and values. Patients reported varying perceptions and understanding of personal risk and clinical benefits of ACT. For many patients, receiving a clear treatment recommendation from the provider limited their participation in the decision-making process, whether it aligned with their decisional support preferences or not. Findings advance understanding of perceived roles and preferences of patients in SDM processes for cancer treatment under heightened clinical uncertainty, and indicate a notable gap in understanding for decisions made using SDM models in the context of clinical uncertainty. Educational and communication strategies and training are needed to support providers in communicating uncertainty, risk, treatment options, and implementing clinical guidelines to support patient awareness and informed decisions.
AB - The decision to use adjuvant chemotherapy (ACT) after surgical resection for stage II colon cancer remains an area of clinical uncertainty. Many patients diagnosed with stage II colon cancer receive ACT, despite inconclusive evidence of long-term clinical benefit. This study investigates patient experiences and perceptions of treatment decision-making and shared decision making (SDM) for ACT among patients diagnosed with stage II colon cancer. Stage II colon cancer patients engaged in treatment or follow-up care aged >18 years were recruited from two large NYC health systems. Patients participated in 30-60-min semi-structured interviews. All interviews were transcribed, translated, coded, and analyzed using a thematic analysis approach. We interviewed 31 patients, of which 42% received ACT. Overall, patient perspectives indicate provider inconsistency in communicating ACT harms, benefits, and uncertainties, and poor elicitation of patient preferences and values. Patients reported varying perceptions and understanding of personal risk and clinical benefits of ACT. For many patients, receiving a clear treatment recommendation from the provider limited their participation in the decision-making process, whether it aligned with their decisional support preferences or not. Findings advance understanding of perceived roles and preferences of patients in SDM processes for cancer treatment under heightened clinical uncertainty, and indicate a notable gap in understanding for decisions made using SDM models in the context of clinical uncertainty. Educational and communication strategies and training are needed to support providers in communicating uncertainty, risk, treatment options, and implementing clinical guidelines to support patient awareness and informed decisions.
KW - Chemotherapy
KW - Clinical practice guidelines
KW - Colon cancer
KW - Guideline implementation
KW - Patient decision making
KW - Shared decision making
UR - http://www.scopus.com/inward/record.url?scp=85119625692&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85119625692&partnerID=8YFLogxK
U2 - 10.1093/tbm/ibab040
DO - 10.1093/tbm/ibab040
M3 - Article
C2 - 34042154
AN - SCOPUS:85119625692
SN - 1869-6716
VL - 11
SP - 1905
EP - 1914
JO - Translational behavioral medicine
JF - Translational behavioral medicine
IS - 10
ER -