Quality-of-Life Preferences in Treatment Decision Making

July 22, 2020

Both patients and clinicians agreed that preferences related to quality-of-life should be considered in treatment decision making, though barriers still remain.

Both patients with cancer and oncology clinicians reported that preferences related to quality-of-life (QoL) should be considered in treatment decision making, yet barriers to shared decision making (SDM), preference elicitation, and documentation still remain, according to a cross-sectional study published in Cancer.

“Ongoing work is needed to help overcome barriers to preference elicitation and SDM to improve patient engagement in decision making and better align cancer treatment with patients’ personal priorities,” the authors wrote.

Using nationwide data collected by CancerCare, researchers sought to better understand current patterns of SDM among patients with cancer and their oncology clinicians.

Patient surveys included questions about the importance of QoL preferences and discussions regarding QoL priorities with their clinicians. Clinician surveys included questions about the discussion of QoL priorities and preferences with patients, the effect of QoL priorities on treatment recommendations, and QoL priority documentation in practice.

Of the 320 patients who completed the survey, the majority were found to be predominantly women (95%) between the ages 45 and 64 years (63%) who had been diagnosed with breast cancer (59%) or were in active cancer treatment (59%). Moreover, of the 112 clinicians who completed the survey, the majority identified as hematologists or oncologists (66%), practiced at an academic hospital or medical center (35%) or a nonhospital-affiliated community practice (30%), and spent more than 75% of their time in direct patient care (79%).

Overall, though 67% of clinicians reported knowing their patients' personal QoL priorities and preferences before finalizing treatment plans, only 37% of patients reported that these discussions were had before treatment initiation. Furthermore, most patients (95%) considered out-of-pocket expenses important during treatment planning, however only 59% reported discussing out-of-pocket expenses with their clinician before finalizing treatment plans.

“This disconnect between patient importance and practice documentation may be explained by barriers previously reported by clinicians, including patient anxiety; SDM inapplicability because of patient engagement preferences or clinical scenario, clinical encounter, and workflow time constraints; and the costs of implementing SDM support systems, such as electronic medical record (EMR) modifications,” the authors noted.

Importantly, a majority of clinicians (52%) considered clinic questionnaires as feasible to document QoL priorities and preferences. However, when considering a phone conversation between office staff and patients for QoL priorities and preferences documentation, a majority of clinicians (51%) considered this strategy to be “impossible or difficult to implement.”

“For SDM to become an integral part of clinical practice, additional implementation strategies are needed to systematically collect and document patient preferences, display key data to patients and clinicians, and facilitate both communication and documentation of these conversations,” the authors wrote.

Notably, some concerns have been raised regarding the use of SDM in payment reform because of the oversimplification of how decisions are made, minimal knowledge on how to optimally incorporate preferences and values into decisions, and lack of clinician awareness on how to engage patients in SDM. Ultimately, the researchers suggested that more research

is needed to address these barriers and to facilitate engaging patients in decisions in a meaningful and shared approach.

Reference:

Williams CP, Miller-Sonet E, Nipp RD, Kamal AH, Love S, Rocque GB. Importance of Quality-of-Life Priorities and Preferences Surrounding Treatment Decision Making in Patients With Cancer and Oncology Clinicians. Cancer. doi: 10.1002/cncr.32961.