Cancer patients’ awareness and role in family-based medical decision-making mode in Confucian area.

Abstract

227 Background: Medical decision making of Chinese patients was family based, which was criticized for the latent moral risk. However, few studies have systematically illustrated the risks of the mode. We aimed to illustrate the determinant of patients’ role in decision making. Methods: A total of 644 adult cancer patients were included in this study between September 1, 2013 and December 31, 2013 from 13 leading general hospitals across China. A questionnaire was give to the oncologists in charge to evaluate each patient concerning the interaction between family and cancer patients, patients’ awareness of disease and participation in medical decision making in mainland China. In this study, the family statuses of patients were ranked as superordinate (one who was the major decision maker in family), equality (one discussed important issues with family members), and subordinate (those who usually don’t be involved in significant family issues). Results: Among the 644 cancer patients, only 125 (19.4%) patients made decision themselves. 291 (45.2%) patients delegated decision making to their family. The rest of 228 (35.4%) patients were involved in decision making. Patients with nonlocal insurance, which meant they traveled to the major cities for advanced medication, were inclined to let their family members make decision for them. Patients’ family status significantly determined their participation in medical decision making. Patients, as superordinate family members, tend to play a positive role in medical decision. By contrast, patients with subordinate role in family continued to play a passive role in medical decision making. Violation of medical recommendation increased according to the severity of patients’ prognosis. The reasons of violation were mainly financial problems. Distrust to doctors presented in merely about 5% of the cases. And conflicts between family members were extremely scarce. Bad news was always hidden from patients, especially for those with incurable disease. Conclusions: Medical decision making of Chinese cancer patients was family based. Patients’ awareness of disease and participation in medical decision making relied on their family status and family financial situation.