Assessment of how differences in efficacy and toxicity change healthcare professionals’ views on presentation of treatment options.

Abstract

e18723 Background: Guidelines for improving healthcare delivery, and the patient experience, call for physicians to inform patients of all available treatment options with comparable efficacy. However, high level evidence comparing options is often unavailable, and “comparable” is subjective. This problem is compounded in oncology, since the main therapeutic modalities are all administered by different types of oncologists (surgical, medical, and radiation) whose cross-training in the risks and benefits of other modalities is incomplete. The purpose of this study was to determine how healthcare professionals’ views on which treatment options should be presented to a patient differ with variations in efficacy and toxicity. Methods: An electronic survey was sent to 1,683 physicians, trainees, nurses, therapists, researchers, and administrators at an NCI-designated Cancer Center. The survey asked participants to imagine being diagnosed with a potentially life-threatening medical disease that can be treated by two standard procedures: Procedure A performed by Doctor A or Procedure B performed by Doctor B. Participants were asked to rate the importance of Procedure B being presented as an alternative to Procedure A for several scenarios of varying cure rate and toxicity risk on a Likert-type scale ranging from 1 (Not at all important) to 5 (Extremely important). Descriptive statistics for all respondents, and subgroup analysis using the Mann-Whitney U and Kruskal-Wallis H tests, are reported. Results: 286 individuals responded (17% response rate). Table 1 shows the percentage of respondents who believed it very or extremely important that Procedure B be discussed as a reasonable alternative to A. On subgroup analysis, no significant difference between physicians (n = 65) and other healthcare professionals (n = 184) was observed for either scenario where the difference in efficacy was only 5%. However, when the difference in cure rate was large (80% vs. 50%), physicians were significantly less likely than all others to believe that discussing Procedure B was important, with mean Likert-type rating 2.55 vs. 2.99, respectively ( p= 0.023) if A and B had the same toxicity risk; 3.40 vs. 3.77, respectively ( p= 0.022) if A had higher toxicity; and 3.74 vs. 3.98, respectively ( p= 0.048) if A had risk of death. No significant differences were observed based on field of oncology (medical vs. surgical vs. radiation) or physicians’ stage of training (attending vs. resident/fellow). Conclusions: Most healthcare professionals favor a balanced discussion of treatment options across a range of differential efficacy, especially when there is also variable risk toxicity or death. [Table: see text]