Abstract
BackgroundMedical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient. Clinicians often use the Eastern Clinical Oncology Group (ECOG) performance status (PS) scores to help them make treatment-related decisions.MethodsThe current study explores the variability of the ECOG score when applied to 12 predetermined specially designed clinical case vignettes presented to a group of oncology clinicians (n = 72). The quantitative analysis included evaluation of variability of ECOG PS scores and exploration of rater and patient-related factors which may influence the final ECOG rating. In-depth interviews were conducted with oncology clinicians to ascertain factors that they felt were important while making treatment-related decisions. Basic and global themes were generated following qualitative data analysis.ResultsQuantitative results showed that there was poor agreement in ECOG rating between raters. Overall concordance with the gold standard rating ranged between 19.4% and 56.9% for the vignettes. Moreover, patients deemed to have socially desirable qualities (p < 0.004) were rated to have better PS and women patients (p < 0.004) to have worse PS. Clinicians having international work experience had increased concordance with ECOG PS rating. Qualitative results showed that ‘perceived socio-economic background of the patient’, ‘age of the patient’, ‘patient’s and family’s preferences’ and ‘past treatment response’ were the major themes highlighted by respondents that influenced the treatment-related decisions made by clinicians.ConclusionThere is considerable variability in ECOG PS determined by clinicians. Decision-making in oncology is complex, multifactorial and is influenced by rater and patient-related factors.
Highlights
Medical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient
Publication costs for this article were supported by the ecancer Global Foundation
We studied decision-making by oncology clinicians in a developing country setting following a mixed method of enquiry intertwining qualitative and quantitative research methodology
Summary
Medical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient. Clinicians often use the Eastern Clinical Oncology Group (ECOG) performance status (PS) scores to help them make treatmentrelated decisions. Decision-making in oncology is often difficult and is influenced by patient preferences, availability and affordability of viable treatment options, views of the treating clinicians and cultural factors [1]. Eastern Clinical Oncology Group (ECOG) PS, first published in 1982 [3], is routinely used in daily clinical practice, as well as in clinical trials. In clinical trials, it forms part of the eligibility criteria. Scoring the patient on the ECOG PS enables different specialties in oncology to communicate effectively and objectively at multi-disciplinary team meetings. It is extremely important that understanding and application of the PS is correct and reproducible
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