Abstract
BackgroundDecisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes. Furthermore, it has been shown that in some breast cancer centers in Germany, patients participate in MTCs and that participation is associated with sociodemographic and breast cancer center-related factors. Health literacy (HL) has been shown to be predictive for individual health behavior and is an important prerequisite for patient participation in healthcare. However, so far nothing is known about the association between HL and MTC patient participation. To close this gap in research, we analyzed which patient characteristics affect participation in MTCs and whether participation varies between breast cancer centers.MethodsIn a prospective, multicenter cohort study, newly diagnosed breast cancer patients were surveyed directly after surgery (T1) as well as 10 weeks (T2) and 40 weeks (T3) after surgery. After descriptive analysis, t-tests were conducted, correlations for independent variables were run, and logistic multilevel regression analysis was applied to estimate the association between patient participation in MTCs at T1 and HL (HLS-EU-Q16 [1]), sociodemographic and disease-related characteristics (n = 863 patients) and the variation between breast cancer centers (n = 43 centers).ResultsDescriptive results show that 6.8% of breast cancer patients took part in a MTC. The logistic multilevel regression model revealed that patients with an inadequately HL are less likely to participate in MTCs (OR = 0.31, 95%-CI = 0.1–0.9, Pseudo-R2 = 0.06), and participation is dependent on the breast cancer center (ICC = 0.161).ConclusionsThese findings are the first to show significant differences in HL and patient participation in MTCs in a large sample of breast cancer patients. In future research on patient participation in MTCs and HL, questions concerning the organization, communication and decision-making in MTCs with and without patient participation have to be addressed, and patient and provider perspectives must be equally considered.Trial registrationDatabase Health Services Research, VfD_PIAT_12_001630, registered prospectively on 01.03.2012.
Highlights
Decisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes
The aim of the study was to examine how Health literacy (HL), sociodemographic patient characteristics and disease-related patient characteristics are associated with patient participation in MTCs and to what extent patient participation in MTCs varies between breast cancer centers
Patient characteristics Descriptive results show that 6.8% of breast cancer patients in German breast cancer centers took part in MTCs, which is a slightly lower percentage than in other studies based on data from North Rhine-Westphalia [30]
Summary
Decisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes. Multidisciplinary tumor conferences (MTCs) mainly represent the first development as a regular exchange between healthcare professionals [4, 5]. It remains unclear if MTCs could as well incorporate processes and structures of patient centeredness to foster decisions that explicitly consider patient preferences [6, 7]. It has been shown that patient preferences concerning decision-making are not considered systematically in MTCs and treatment recommendations are mainly based on clinical information [11,12,13]. Incorporating patient preferences in MTCs is a central factor in treatment decision-making to achieve higher-quality decisions [15] and to possibly optimize adherence efficiency of MTC decisions [16]
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