Decision-Making Role Preferences of Patients Receiving Adjuvant Cancer Treatment: A University of Rochester Cancer Center Community Clinical Oncology Program

Abstract

This study examined patients' preferences for involvement in treatment decision-making. This was a multisite survey study of 1014 patients diagnosed with a variety of cancers. Patients' treatment decisions, role preferences, and characteristics were assessed with a questionnaire administered at the time of their first visit with a medical or radiation oncologist. The data showed that 35.7% preferred passive roles, 43.7% preferred shared roles, and 20.3% preferred active roles in decision-making. Bivariate analyses indicated that patients with a college education or in professional or managerial occupations preferred more active roles in decisionmaking compared with other patients. Similarly, men with prostate cancer and women with breast cancer, compared with other patients, also preferred more involvement in decision-making. Age was not associated with decision-making role preferences. Avoidant and fatalistic coping were associated with a passive decision-making role. Multinomial logistic regression analysis found that patients in professional/managerial occupations preferred a shared role (odds ratio [OR], 1.6; CI, 1.2–2.4) or an active role (OR, 2.3; CI, 1.5–3.5) compared with patients in other occupations. Patients with prostate or breast cancer preferred shared (OR, 2.3; CI, 1.6–3.2) or active roles (OR, 1.8; CI, 1.2–2.8) compared with patients with other diagnoses. Patients who scored higher on the Mental Adjustment to Cancer fatalism scale were less likely to prefer shared (OR, 0.94; CI, 0.89–0.99) or active roles (OR, 0.90; CI, 0.84–0.96) compared with patients with a less fatalistic orientation. Decision-making role preferences were influenced by multiple factors. Most patients wanted a shared or active role in treatment decision-making. Our results suggest that some patients may require encouragement to take a shared or active role in decision-making.