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Information Giving and Decision-Making in Patients With Advanced Cancer: A Systematic Review
Information Giving and Decision-Making in Patients With Advanced Cancer: A Systematic Review
Information Giving and Decision-Making in Patients With Advanced Cancer: A Systematic Review
com/science/article/pii/S0277953605001802
Cornford House Surgery, 364 Cherry Hinton Road, Cambridge CB2 4PH, UK
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.
http://www.sciencedirect.com/science/article/pii/S0959804908006813
Istituto Nazionale di Riposo e Cura per Anziani (INRCA), U.O. Oncologia, Via
Cassia 1167, 189 Rome, Italy
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.
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.
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.
Keywords
Communication
Elderly patient
http://ascopubs.org/doi/full/10.1200/JCO.2001.19.11.2883
Abstract
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.
http://ascopubs.org/doi/pdf/10.1200/JCO.2002.20.2.503
Abstract
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