The role of families in decisions about cancer treatments.

Abstract

6528 Background: Shared decision-making is an important component of patient-centered care and is associated with improved health outcomes. Little is known about patients’ involvement of family members in decisions about cancer treatments or whether family involvement varies by patient demographic or clinical characteristics. Methods: Data for this study were collected as part of the Cancer Care Outcomes Research and Surveillance (CanCORS) study, a large multi-regional prospective cohort study of cancer care and outcomes of lung and colorectal cancer patients. Patients were surveyed about the roles of their families in decisions about surgery, radiation, and/or chemotherapy. We used multinomial logistic regression to identify patient factors independently associated with family roles in decisions. Results: Among 5284 patients, 28.5% reported little or no family input in decisions, 22.1% reported making decisions after considering the family’s opinion, 47.9% reported the patient and family made decisions together, and 1.5% reported the family made decisions. In adjusted analyses, married, female, older, and insured patients were more likely to report making decisions with their family (all P<.001). Family involvement varied substantially by race/ethnicity and language, with Chinese-speaking Asian (63.5%) and Spanish-speaking Hispanic (56.8%) patients reporting making decisions with their family more often than English-speaking Hispanic patients (48.5%) and whites (48.3%). Patients from Veterans Affairs hospitals were least likely to report making decisions together with family (P<.001). Family involvement varied statistically by cancer type, stage, comorbidity, health status, and depression, but differences were minimal. Conclusions: Most patients with a new diagnosis of lung or colorectal cancer involve family members in treatment decisions. Certain groups, such as non-English speaking Hispanics and Asians rely significantly on family; for these groups, it is important that physicians inquire about patients’ preferences for family involvement and work to integrate family members in decisions accordingly. Further studies are needed to determine the impact of family involvement in treatment decisions on oncology outcomes.