Degner, Lesley F.

8521 Background: The extent of patient involvement in the decision making process for cancer treatment can impact satisfaction with care. A pooled-analysis of clinical studies from the US and Canada incorporating the Control Preferences Scale (CPS) was conducted to produce normalized data regarding patient preferences and examine differences in role preference related to country, tumor type, gender and other demographics. Methods: Patient data culled from six trials indicated the treatment decision making role preferred and the role actually experienced clinically. Fisher’s Exact Tests were performed to compare role distribution concordance and association with clinical and demographic variables. Results: Data available for 3,491 patients indicated that 25% preferred an active role, 46% a collaborative role, and 29% a passive role in their medical treatment decision making. In terms of actual experience, 30% of patients reported taking on an active role, 34% collaborative, and 36% passive. Overall, 61% of patients reported playing the role they prefer. Differences between genders in the preferred role were slight, but males achieved their preferred role more often than females (66% vs. 60%, p=0.011). More women actually took a passive role than men (40% vs. 24%, p<0.0001) as did more patients in the US than Canada (84% vs. 54%, p<0.001). Canadian patients preferred more passive than active roles (33% vs 22.4%) and US patients preferred more active to passive roles (31.9% vs 14.2%) (p<0.001). Older patients preferred a more passive role and took on that role. Differences in role preference across tumor types were negligible. Conclusions: Roughly one half of the cancer patients studied indicated that they preferred to have a collaborative relationship with physicians, the remaining patients split equally between an active and passive role. The US cohort seemed to want to be more assertive than their Canadian counterparts and women ended up playing a more passive role than they preferred. Given these gender and cross-county differences these findings highlight the need for individualized patient communication styles to be incorporated into treatment plans No significant financial relationships to disclose.

Dieser zweiteilige Artikel stützt sich auf ein vergleichendes und beschreibendes Modell, anhand dessen sich die Wahrnehmungen der Symptombelastung von Lungenkrebspatientinnen und -patienten und die Einschätzungen der sie hauptsächlich pflegenden Angehörigen im familiären Rahmen untersuchen lassen. Der zweite Teil beschreibt die Resultate der qualitativen Komponente dieser Untersuchung. Eine Auswahl von 37 Paaren, die aus Patient/in und pflegendem Familienmitglied bestanden, füllte die McCorkle and Young Symptom Distress Scale (SDS) aus. Die Gesamtresultate der pflegenden Angehörigen korrelierten mäßig1 mit jenen der Patienten (r = 0.71; P < 0.001). Bei 10 der 13 Symptome fanden sich keine bedeutsamen Unterschiede in der Einstufung. Pflegende sollten sich daher bewußt sein, daß die pflegenden Angehörigen die Symptombelastung von Lungenkrebspatienten bei mindestens 10 der 13 auf der SDS aufgeführten Symptome zuverlässig einschätzen. Dies ist vor allem dann von großer Bedeutung, wenn der Patient oder die Patientin selbst nicht in der Lage ist, über seine/ihre Symptombelastung zu sprechen.