Patient's Decisional Control Preferences in Palliative Care: An Indian Survey

Abstract

Background: The frequency of passive decisional control (patients prefers physician to make decisions) has been reported to be variable but generally larger among patients living in developing countries. Aim: This study aimed to determine the frequency of passive DCP among patients with advanced cancer in a tertiary cancer center, and identify its association with their sociodemographic and clinical characteristics. Methods: 150 patients referred to palliative care underwent assessment of decisional control preferences using validated tools including control preference scale tool, satisfaction with decision scale and understanding of illness questionnaire. Information regarding patient characteristics including age, gender, education, marital status, employment, Karnofsky Performance Scale, cancer stage and type, religion were also collected. Descriptive statistics and logistic regression analysis were performed. Results: Median age was 48 years, Karnofsky 90, and 55.3% were men. Shared, active (patient prefers to make decision by his/her own) and passive DCP were 20.7%, 26.7% and 52.7% respectively (n = 150). 51.3 were satisfied by the way the actual decisions were made. 70.7% felt that their cancer was curable. Passive DCP did not vary across regions. Multivariate analysis shows that the passive DCP was significantly associated in better KPS [expB 1.07 (1.01-1.15), P = 0.03]. Conclusion: There are significant differences in DCP with KPS. Patients report high level of satisfaction with their treatment decision, though they have poor understanding of their prognosis and understand their treatment to be of curative intent. Individualized understanding DCP and focus on illness understanding may be important for quality care and patient satisfaction outcomes.