Patient Information and Decision Aids in Oncology: Need for Communication Between Patients and Physicians

Abstract

TO THE EDITOR: In their recent contribution to Journal of Clinical Oncology, Brace et al report on the knowledge and opinions of physicians caring for patients with cancer in the province of Ontario, Canada, about patient decision aids. Decision aids have been defined as “interventions designed to help people make specific and deliberative choices among options by providing information about the options and outcomes that is relevant to a person s health status.” Such tools play a role in assisting patients in making informed decisions about specific treatment options (eg, surgery v radiotherapy v watchful waiting in early-stage prostate cancer) and also in opting for or against cancer screening procedures. In their questionnaire survey, Brace et al found that, of 477 responders, 69% were aware of patient decision aids and 24% (40% of responding medical oncologists) actually used decision aids in their practices. Brace et al must be congratulated for collecting this comprehensive data set on the oncologists’ perspective on this important topic. However, it is possible that the rates of decision aid use by patients may actually be higher than suggested by the percentages for physicians responding to the questionnaire. Access to diseasespecific patient decision aids is provided freely on the Internet, and patients may make use of these tools without discussing them with their treating oncologists. We have been interested in patterns of patient information (eg, the importance of specific media or the rate of Internet use to obtain such information) in radiation oncology. In two independent crosssectional surveys of patients undergoing radiotherapy at university radiation oncology departments in Germany in the years 2000 and 2008, we found rates of 21% and 41%, respectively, of patients with cancer who had obtained information about the disease or its treatment via the Internet. Importantly, of those who received information via the Internet, only 24% (2000 study) and 39% (2008 study) stated that they had discussed the information with their treating physicians. Applying these findings to the physician data on decision aids, which may be limited by different settings and cultural backgrounds, one could speculate that the actual use of decision aids by patients with cancer may be much higher than reflected by the data of Brace et al. A previous meta-analysis of randomized controlled trials of the effects of cancer-related decision aids suggested that the knowledge of patients with cancer is increased, whereas their anxiety is not—an effect that was most clearly shown for screening decisions. Improving communication between patients and oncologists about information, including decisions aids, obtained via the Internet should serve two purposes: to provide patients with access to objective additional information that is helpful in the decision-making process and to integrate this knowledge into the patient-physician interaction.