Involvement In Treatment Decisions Research Articles

Vascular Mock Oral Exams: A Review of the 8-Year Experience of the SAVS Mock Oral Program

categoric variables or mean 6 standard deviation for continuous variables. Categoric responses are presented as median (interquartile range) based on a 1-5 ordinal scale. Results: The participants were 74 patients undergoing intervention for abdominal aortic aneurysm (n 1⁄4 20), hemodialysis access (n 1⁄4 14), carotid stenosis (n 1⁄4 20), and peripheral arterial disease (n 1⁄4 20). Mean age was 68.86 12.4 years, 43% were women, and 26% were African American. Highest educational level was college or graduate school for 35% of participants, 61% had computer access, and 41% regularly used e-mail. Participants identified providers as the most important information sources (1 [1, 1] for doctors and 2 [1, 3] for nurse practitioners, where 11⁄4 “very important” and 51⁄4 “not important”), whereas family and friends, writtenmaterials, and other patients were less important (3 [1, 5], 3 [2, 4], and 3 [2, 5], respectively), and television/video and internet resources were least important (4.5 [3, 5] and 5 [3, 5], respectively). Although participants had high levels of confidence in provider recommendations (1 [1, 1] for all procedure categories, where 11⁄4 “very satisfied” and 5 1⁄4 “not satisfied”), they had a strong preference to discuss all potential treatment options (1 [1, 1], where 1 1⁄4 “strongly agree” and 5 1⁄4 “strongly disagree”) and to choose their treatment together with their doctor (1 [1, 2]) as opposed to only discussing the recommended treatment (2 [1, 3]) or delegating selection to the doctor alone (2 [1, 3]). Patients undergoing hemodialysis access and abdominal aortic aneurysm procedures most often reported discussion of more than one option (1.5 [1, 3] and 1.5 [1, 5], respectively), whereas discussion of multiple options was less common for peripheral arterial disease (2 [1, 3.5]) and carotid stenosis (3 [1, 5]). Thirty-seven participants (50%) considered their first treatment successful, 27 (36.5%) considered another subsequent treatment successful, and 10 (13.5%) considered none successful. Conclusions: Patients experience varying participation levels in decision making for vascular procedures and often believe that their treatments are unsuccessful. Although patients consider providers an important source of information and have confidence in their recommendations, they prefer to discuss all treatment options being considered. Patients also prefer shared decision making over complete delegation to the provider. Increasing patient involvement in treatment decisions has potential to improve patient satisfaction but may require tools to facilitate more active participation. Potential impacts on other outcomes remains to be determined.

Exploring Patient Involvement in Decision Making for Vascular Procedures

Initiatives to develop patient-centered approaches to health care are a priority that may have profound effects on health care, particularly within value-based purchasing and risk-sharing models. Patient-centered care requires more direct engagement of patients in their own care, including treatment decisions. Patient participation in treatment selection for vascular procedures has not been characterized, and the potential effects of greater patient involvement are unknown. We conducted a prospective study among patients undergoing vascular procedures to identify important sources of information and characterize experienced vs desired decision-making roles. Patients undergoing elective vascular procedures were identified from an outpatient clinic and vascular laboratory. An instrument consisting of multiple choice and open-ended response items related to patients' roles in decision making, sources of information, and perceived treatment success was administered. Diagnostic, demographic, and educational data were collected. Descriptive statistics are presented as count (%) for categoric variables or mean ± standard deviation for continuous variables. Categoric responses are presented as median (interquartile range) based on a 1-5 ordinal scale. The participants were 74 patients undergoing intervention for abdominal aortic aneurysm (n = 20), hemodialysis access (n = 14), carotid stenosis (n = 20), and peripheral arterial disease (n = 20). Mean age was 68.8 ± 12.4 years, 43% were women, and 26% were African American. Highest educational level was college or graduate school for 35% of participants, 61% had computer access, and 41% regularly used e-mail. Participants identified providers as the most important information sources (1 [1, 1] for doctors and 2 [1, 3] for nurse practitioners, where 1 = “very important” and 5 = “not important”), whereas family and friends, written materials, and other patients were less important (3 [1, 5], 3 [2, 4], and 3 [2, 5], respectively), and television/video and internet resources were least important (4.5 [3, 5] and 5 [3, 5], respectively). Although participants had high levels of confidence in provider recommendations (1 [1, 1] for all procedure categories, where 1= “very satisfied” and 5 = “not satisfied”), they had a strong preference to discuss all potential treatment options (1 [1, 1], where 1 = “strongly agree” and 5 = “strongly disagree”) and to choose their treatment together with their doctor (1 [1, 2]) as opposed to only discussing the recommended treatment (2 [1, 3]) or delegating selection to the doctor alone (2 [1, 3]). Patients undergoing hemodialysis access and abdominal aortic aneurysm procedures most often reported discussion of more than one option (1.5 [1, 3] and 1.5 [1, 5], respectively), whereas discussion of multiple options was less common for peripheral arterial disease (2 [1, 3.5]) and carotid stenosis (3 [1, 5]). Thirty-seven participants (50%) considered their first treatment successful, 27 (36.5%) considered another subsequent treatment successful, and 10 (13.5%) considered none successful. Patients experience varying participation levels in decision making for vascular procedures and often believe that their treatments are unsuccessful. Although patients consider providers an important source of information and have confidence in their recommendations, they prefer to discuss all treatment options being considered. Patients also prefer shared decision making over complete delegation to the provider. Increasing patient involvement in treatment decisions has potential to improve patient satisfaction but may require tools to facilitate more active participation. Potential impacts on other outcomes remains to be determined.

Communication Between HIV Patients and Their Providers: A Qualitative Preference Match Analysis

Since the introduction of cART (combination antiretroviral therapy), HIV has evolved into a chronic disease such that it requires lifelong medical treatment to which patients must adhere. Communication with health care providers is pivotal in supporting patients to adapt to having HIV and adhering to treatment, in order to maintain health and quality of life. Previous research indicates that communication is optimal when it matches patient preferences for information exchange, relationship establishment, and involvement in treatment decisions. The aim of the present study is to explore HIV patient communication preferences as well as patient experiences with their providers (not) matching their preferences. A second aim is to explore provider beliefs about patient preferences and provider views on optimal communication. Data were collected through interviews with 28 patients and 11 providers from two academic hospitals. Results indicate that patient preferences reflect their cognitive, emotional, and practical needs such that patients look to increase their sense of control over their HIV. Patients aim to further increase their sense of control (by proxy) through their relationship with their providers and through their decisional involvement preferences. Providers are well aware of patient communication preferences but do not explicate underlying control needs. Implications for clinical practice are discussed.

Cognitive coping style (monitoring and blunting) and the need for information, information satisfaction and shared decision making among patients with haematological malignancies.

A haematological malignancy is a serious, life-altering disease and may be characterised as an uncontrollable and unpredictable stress situation. In dealing with potentially threatening information, individuals generally utilise two main cognitive coping styles: monitoring (the tendency to seek threat-relevant information) and blunting (avoiding threatening information and seeking distraction). The aim of this study was to obtain insight into the association between cognitive coping style and (a) need for information, (b) satisfaction with information, (c) involvement in decision making, and (d) quality of life (QoL). In this cross-sectional study, coping style was assessed among adult patients diagnosed with a haematological malignancy, using an adapted version of the Threatening Medical Situations Inventory. Information need, information satisfaction, decision-making preference and QoL were measured with validated questionnaires. In total, 458 patients returned the questionnaire (66%). A monitoring coping style was positively related to need for both general and specific information. Blunting was positively and QoL was negatively related to need for information. Monitoring was positively related to involvement in decision-making and negatively to information satisfaction. Using multivariate analysis, this relation between monitoring and information satisfaction disappeared, and for blunting, we found a negatively significant relation. QoL was not related to coping style. Among patients with haematological malignancies, coping style is related to a need for information, information satisfaction, and involvement in treatment decision-making. Therefore, it is important for health care professionals to be aware of individual differences in cognitive coping style.

Factors influencing patients’ preferences and perceived involvement in shared decision-making in mental health care

Background: Although research has suggested that patients desire to participate in shared decision-making, recent studies show that most patients take a passive role in their treatment decisions. The discrepancy between patients’ expressed desire and actual behaviors underscores the need to better understand how patients perceive shared decision-making and what factors influence their participation.Aims: To investigate patients’ preferences and appraisals of their involvement in treatment decisions.Methods: Fifty-four qualitative interviews were conducted with veterans receiving outpatient mental health care at a U.S. Veterans Affairs Medical Center. Interviews were analyzed using thematic analysis.Results: Participants outlined several factors that influence their preferences and involvement in treatment decisions. These include the patient–provider relationship, fear of being judged, perceived inadequacy, and a history of substance abuse.Conclusion: Patients’ preferences and willingness to engage in shared decision-making fluctuate over time and are context dependent. A better understanding of these factors and a strong patient–provider relationship will facilitate better measurement and implementation of shared decision-making.

James Mackenzie Lecture 2013: the Tao of family medicine.

General practice faces the challenges of an increase in the prevalence of long-term conditions (LTCs) and multimorbidity, coupled with increasing demand and the need for more collaborative partnerships with patients. To address these challenges, I believe we need a fundamental change in our definitions of health and health care, the way we ‘do’ general practice, and a transformation in our relationships with our patients. ### An increase in long-term conditions and multimorbidity An LTC is generally defined as any medical condition that cannot currently be cured but can be managed with the use of medication and/or other therapies. More than 15 million people in England have LTCs: accounting for some 30% of the population and 70% of NHS spend.1 People with LTCs account for at least 50% of all GP appointments. To address this challenge we need a new definition of health; one that includes the ability to ‘adapt and self-manage’,2 and which can provide a framework which focuses on the empowerment of patients and improves doctor and patient communication. ### Increasing demands on GPs Between 1995 and 2008 there was a 75% increase in the number of GP consultations, from 171 to >300 million consultations per year. The average number of consultations/person/year also increased from 3.9 to 5.5 and the length of consultations increased from a mean of 8.4 minutes to 11.7 minutes.3 There has also been a rise in the complexity of the problems that our patients present to us. ### Patients want better partnerships with GPs The evidence is unequivocal that our patients want improved collaborative partnerships with us: NHS patient surveys consistently show that 46–49% of patients want more involvement in treatment decisions. Recent responses to this challenge include initiatives such as care planning,4 support for self-management,5 and shared decision-making initiatives.6 ### Care planning Figure 1 shows the ‘House of Care’7 approach to care planning which has been pioneered by Diabetes UK …

Information Needs of Older Women Faced with a Choice of Primary Endocrine Therapy or Surgery for Early-Stage Breast Cancer: A Literature Review

Primary endocrine therapy (PET) as an alternative to surgery is widely used in the UK for the treatment of older women with operable breast cancer. For women over 70 it has equivalent overall survival to surgery, although local control rates may be inferior. There are trade-offs to be made in deciding between surgery and PET. There has been little research to investigate the information needs of older women or the involvement in decision making they wish to have when faced with this breast-cancer treatment decision. This review examines the information needs of older women (>65 years) regarding the use of surgery or PET for treating operable primary breast cancer, and identifies their preferred format and media for the presentation of this information. The preference for involvement in treatment decision-making among this group will also be considered. © 2014 Springer Science+Business Media.

Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians.

Background:Vaginal brachytherapy (VBT) in high–intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making.Methods:Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making.Results:Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, P<0.001), for irradiated than for non-irradiated patients (median=0 vs 6.5%, P<0.001), and for radiation oncologists than for gynaecologists (median=4 vs 13%, P<0.001). Substantial variation existed within the groups of patients and clinicians. Participants preferred the patient and clinician to share in the decision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making.Conclusions:We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.

Experiences of Surgical Continence Management Approaches for Cloacal Anomalies: A Qualitative Analysis Based on 6 Women

Study ObjectiveThe aim of this qualitative study was to gain insight into health care experiences of young women diagnosed with cloacal anomalies, with a special focus on continence management. DesignQualitative analysis of one-to-one interviews. SettingA tertiary center for congenital anomalies of the urogenital tract in London. ParticipantsSix women aged 16 to 24 with cloacal anomalies. InterventionsTape-recorded one-to-one semi-stuctured interviews with a skilled interviewer. Main Outcome Measure(s)The taped interviews were transcribed and analyzed verbatim using interpretative phenomenological analysis according to the research question. Organizing themes across all of the accounts were identified. ResultsTwo organizing themes concerning our research interests are summarized. The first theme Personal Agency in the Hands of Experts focuses on the interviewees’ appreciation of their life-saving surgical care and their involvement in treatment decisions. The second theme Compromises and Trade-Offs focuses on what it was like to live with the more traditional versus the more advanced continence methods. Reliability emerged as a key priority in terms of continence treatment outcome. Gratitude may have interfered with the women’s honest communications during treatment decision and evaluation consultations. ConclusionsA more developed approach to communication about the complex interventions proposed, founded on a nuanced understanding of users perspectives, can enhance informed decision making about continence management approaches. Despite these specific gaps, the interviewees were appreciative of their care and optimistic about life.

Assessing patient-caregiver communication in cancer--a psychometric validation of the Cancer Communication Assessment Tool (CCAT-PF) in a German sample.

The recently introduced Cancer Communication Assessment Tool (CCAT-PF) measures congruence in patient-caregiver communication and was initially validated in lung cancer patients. Contributing to a greater proportion of the variance in the conflict scores, primary caregivers were hypothesized to experience greater stress. For a detailed understanding of conflicting communication patterns of cancer-affected families, our study aimed for psychometric validation of the CCAT-PF in a sample covering heterogeneous tumor entities. Subsequent to a cross-sectional survey of 189 pairs of cancer patients (31% gastrointestinal, 34% lung, and 35% urological) and their caregivers' exploratory factor analysis with principal component condensation and varimax rotation was conducted (response rate, 74.2%). Reliability and construct validity were assessed calculating Cronbach's α and Pearson correlation coefficients for CCAT-P and CCAT-F scales and related constructs, respectively. Cancer-related communication according to the CCAT-PF can be subdivided into four factors including the scales Disclosure, Limitation of treatment, Family involvement in treatment decisions, and Continuing treatment. Reliability ranged from α = .51-.68. The Disclosure scale, describing poor cancer-related communication of the patient, was correlated with patient's distress (QSC-R10: r = .30, p < .0001), unmet needs in several areas (SCNS-SF-34: r = .25-.32, p < .001), and negatively with social/family well-being (FACT: r = -0.31, p < .0001). Higher scores on the scale were significantly associated with considerable decrements in emotional well-being especially for caregivers perceiving patients' disclosure as problematic. The Disclosure scale originating from the CCAT-PF emerged as a short, valid, and reliable stand-alone instrument for identifying conflicting communication in patient-caregiver-dyads at risk.

Older women's experience with breast cancer treatment decisions.

The purpose of this study was to better understand older women's experience with breast cancer treatment decisions. We conducted a longitudinal study of non-demented, English-speaking women ≥ 65 years recruited from three Boston-based breast imaging centers. We interviewed women at the time of breast biopsy (before they knew their results) and 6 months later. At baseline, we assessed intention to accept different breast cancer treatments, sociodemographic, and health characteristics. At follow-up, we asked women about their involvement in treatment decisions, to describe how they chose a treatment, and influencing factors. We assessed tumor characteristics through chart abstraction. We used quantitative and qualitative analyses. Seventy women (43 ≥ 75 years) completed both interviews and were diagnosed with breast cancer; 91 % were non-Hispanic white. At baseline, women 75+ were less likely than women 65-74 to report that they would accept surgery and/or take a medication for ≥ 5 years if recommended for breast disease. Women 75+ were ultimately less likely to receive hormonal therapy for estrogen receptor positive tumors than women 65-74. Women 75+ asked their surgeons fewer questions about their treatment options and were less likely to seek information from other sources. A surgeon's recommendation was the most influential factor affecting older women's treatment decisions. In open-ended comments, 17 women reported having no perceived choice about treatment and 42 stated they simply followed their physician's recommendation for at least one treatment choice. In conclusion, to improve care of older women with breast cancer, interventions are needed to increase their engagement in treatment decision-making.

Barriers to health information seeking in Iranian patients with cardiovascular disease: A qualitative study

ObjectiveProviding patients with health care information is a critical component of the process of cardiovascular disease (CVD) management. The purpose of this study was to explore obstacles to seeking health care information among cardiovascular patients from the perspectives of patients, their family caregivers, and health care providers. MethodsThis study was conducted with a qualitative approach using conventional qualitative content analysis. The study included 31 Iranian participants including 16 cardiovascular patients, 5 family members, and 10 health care providers (multidisciplinary). Data were collected with semi-structured interviews and continued to the point of data saturation. Analysis of the data was performed continually and concurrently with data collection of using a comparative method. ResultsFive themes emerged including ‘poor quality of information provision,’ ‘mutual ambiguity,’ ‘beliefs, faith, and expectations,’ ‘from routine life to obtaining information,’ and ‘conditions governing information seekers.’ Seven sub-themes indicated participants' experiences and understandings of obstacles in health care information seeking. ConclusionHealth care information seeking in cardiovascular patients and their family members occurs as a result of the influence of beliefs, interaction with numerous information sources, and in the context and structure that the care and information are provided. Understanding the nature of obstacles to health information seeking will help health care policy makers to provide evidence-based, reliable, and patient-centered information to encourage cardiovascular patients' involvement in treatment decisions.

How Much Shared Decision Making Occurs in Usual Primary Care of Depression?

Shared decision making (SDM) is an important component of patient-centered care, but there is little information about its use in the primary care of depression, so we sought to study its frequency in usual care as reported by patients. Telephone interview of 1168 depressed patients taking antidepressants in 88 Minnesota primary care clinics who were identified from pharmacy claims data soon after a prescription for an antidepressant. We measured depression severity with the 9-item Patient Health Questionnaire and used a composite measure of SDM that reflected patient involvement in treatment decisions. These patients reported an average score for SDM of 50.7 (standard deviation, 32.8) on a scale of 0 to 100, where higher scores equate with greater SDM. In univariate analyses, the largest differences among scores were for age (scores of 58, 53, 45, and 33 for those aged 18-34, 35-49, 50-64, and >64 years, respectively; P < .0001); duration of treatment (a score of 56.6 on treatment <6 weeks vs 45.5 if longer; P < .001); and other treatments in the past 6 months (60.5 if yes vs. 46.0 if no; P = .001). SDM was not associated with any clinic characteristics, but it was correlated with patient-reported quality of care (r = 0.48; P < .001). Multivariate analyses confirmed some of these findings while showing a more complex set of relationships. Older patients with depression and those who have been in treatment longer report much less SDM in their care. Improving SDM, especially for these groups, may be an important target for improving patient experience and perceived quality.

Navigating healthcare: a qualitative study exploring prostate cancer patients' and doctors' experience of consultations using a decision‐support intervention

Men with prostate cancer face preference-sensitive decisions when choosing among treatments with similar survival outcomes but different procedures, risks and potential complications. A decision-support intervention, 'Decision Navigation' assists men with prostate cancer to prepare a question list (consultation plan) for their doctors and provides them with a consultation summary and audio recording. A randomised controlled trial of Decision Navigation showed advantages over usual care on quantitative measures including confidence in decision-making and regret. The aim of this study was to gain a qualitative understanding of patient's and doctor's perspectives on Decision Navigation. Six patients who received Decision Navigation were purposively selected for interview out of 62 randomised controlled trial participants. All four doctors who consulted Navigated patients were interviewed. Interview data was analysed using framework analysis. Patients reported that planning for the consultation helped them to frame their questions, enabling them to participate in consultations and take responsibility for making decisions. They reported feeling more confident in the decisions made, having a written report of the key information and an audio recording. Patients considered routine information relating to side effects was inadequate. Doctors reported that consultation plans made them aware of patients' concerns and ensured comprehensive responses to questions posed. Doctors also endorsed implementing Decision Navigation as part of routine care. Results suggest that Decision Navigation facilitated patients' involvement in treatment decision-making. Prostate patients engaging in preference-sensitive decision-making welcomed this approach to personalised tailored support.

Preference for involvement in treatment decisions and request for prognostic information in newly diagnosed patients with higher-risk myelodysplastic syndromes

The main objective of this study was to assess preferences for involvement in treatment decisions and requests for prognostic information in newly diagnosed higher-risk myelodysplastic syndrome (MDS) patients. This was a prospective cohort observational study that consecutively enrolled MDS patients with an international prognostic scoring system (IPSS) risk category of intermediate-2 or high risk (summarized as 'higher risk'). The control preference scale was used to assess patient preferences for involvement in treatment decisions, and whether a request by patients for prognostic information during consultation was made, was also recorded. All of the patients were surveyed at the time of diagnosis before receiving treatment. Univariate and multivariate analyses were carried out to assess how sociodemographic, clinical and laboratory data related to decision-making preferences and requests for prognostic information. Relationship with the health-related quality of life (HRQOL) profile was also examined. A total of 280 patients were enrolled, 74% with intermediate-2 and 26% with high-risk IPSS. The mean age of patients was 70-year old (range: 32-89 years). One hundred thirty-two patients (47%) favored a passive role in treatment decision-making, whereas only 14% favored an active role. The remaining 39% of patients favored a shared decision-making approach. Patients with lower hemoglobin levels were more likely to prefer a passive role (P=0.037). HRQOL was generally better in patients preferring an active role versus those preferring a passive one. Overall, 61% (N=171) of patients requested prognostic information on survival during consultation. The likelihood of not requesting prognostic information was higher for older patients (P = 0.003) and for those with lower education (P=0.010). Decision-making preferences vary among patients with newly diagnosed higher-risk MDS. Current findings suggest that patients with worse underlying health conditions are more likely to prefer less involvement in treatment decisions.

Using a web-based decision support intervention to facilitate patient-physician communication at prostate cancer treatment discussions

Purpose: To measure the preferences and values of men newly diagnosed with prostate cancer (PC) using a web-based decision support technology—the Decision Support Intervention-Prostate Cancer (DSI-PC). Methods: Health information seeking behaviour, factors having an influence on the treatment decision, decision control, and preferred treatment were recorded by the DSI-PC program prior to the treatment consultation. A summary page of responses was provided to each patient to use at treatment discussions. Measures of decision control and decision conflict were measured prior to the treatment discussion, and following a treatment decision. Patient satisfaction was measured after a treatment decision had been made. Results: Forty-nine men completed the DSI-PC program prior to their treatment discussion. Sixty-one per cent shared the summary sheet with their physician/s when discussing treatment options. The majority (63%) of patients wanted access to in-depth or detailed information. Impact of treatment on survival, urinary function, bowel function, and physician’s treatment recommendation were the four factors having the most influence on patients’ treatment decisions. Patients reported high levels of satisfaction with their treatment decision, and involvement in treatment decision making (TDM). Levels of decision conflict were significantly lower (p < 0.001) after a treatment decision was made, and men reported assuming a significantly more active role in TDM than originally preferred (p = 0.038). Conclusions: Results suggest that the DSI-PC intervention may be a useful tool to help patients identify and communicate their values and preferences to physicians at the time of treatment discussions. Key words: prostate cancer, patient-physician communication, decision support intervention

Disparities in physician-patient communication by obesity status.

This study aimed to examine variations in patient-physician communication by obesity status. We pooled data from the 2005-2007 Medical Expenditure Panel Survey (MEPS),_included only individuals who completed the self-administered questionnaire themselves, and restricted the sample to patients who received care from primary care physicians. We included a total of 6,628 unique individuals between the ages of 18 and 65 who had at least one office or hospital outpatient visit during the past 12 months. There are six outcomes of interest in this study. The patient-physician communication composite score is based on five questions that the MEPS adapted from the Consumer Assessment of Healthcare Providers and Systems Survey. The other five variables were: respect from providers, providers’ listening skills, explanations from providers, time spent with patients, and patient involvement in treatment decisions. The key independent variable was obesity. Bivariate and multivariate models such as ordinary least squares (OLS) and logistic regression were used to examine the relationship between patient-physician communication and obesity status. Multivariate models showed that obese patients had a reduced physician-patient communication composite score of 0.19 (95% CI 0.03-0.34, p=0.02), physicians’ show of respect OR 0.77 (95% CI 0.61-0.98, p=0.04), listening ability OR 0.82 (95% CI 0.65-1.02, p=0.07), and spending enough time OR 0.80 (95% CI 0.62-0.99, p=0.04) compared to non-obese patients. We found a negative association between physician-patient communication and patients’ obesity status. These findings may inform public health practitioners in the design of effective initiatives that account for the needs and circumstances of obese individuals.

Patient involvement in surgical treatment decisions and satisfaction with the treatment results after lumbar intervertebral discectomy

To evaluate involvement of patients in surgical treatment decision making (STDM) in relations to satisfaction with the results of lumbar discectomy. We evaluated prospectively 150 surgically treated patients with radicular pain due to lumbar disc herniation (LDH). The patients completed self-reported questionnaires about preferences for involvement and actual involvement in STDM. Global satisfaction with the results of the treatment was assessed at 1 year after the operation. Most of the patients (129 patients, 86%) stated that they had been sufficiently informed about LDH to be involved in the treatment decisions, almost half of the patients (47%) preferred active or collaborative involvement and 58% of the patients reported higher actual involvement in STDM. Congruence between preferred and actual roles in decision making was 64%. Most of the patients (77%) were satisfied with the results of the operation, but satisfaction was not associated with involvement of patients in STDM. A significant proportion of patients with LDH prefer to be actively involved in treatment decisions and experience an STDM process that matches their preferences for participation. However, individual differences in preferences for involvement in STDM are common and global satisfaction with the treatment results is not significantly related to the activity of involvement in STDM.

Informal decision support networks and treatment decisions for breast cancer.

24 Background: Although nearly 80% of breast cancer patients have someone with them during surgical consultations, there is little research that examines the extent, nature, or impact of informal decision support persons (DSPs) such as partner/spouse, other family members, or friends on breast cancer treatment decision making. Methods: Two data sources were used: 1) A population based sample of patients recently diagnosed in 2006/7 in the Detroit and Los Angeles SEER catchment areas completed a survey 9 months (N=1837, 72% response rate); and 2) A pilot survey study of a convenience sample of 150 breast cancer patients at three clinical sites surveyed within 18 months that examined more details on the extent and nature of informal decision support networks, including: a) quantity and type of DSPs involved in their treatments, b) number of appointments attended by DSPs, and c) patient-reported satisfaction with DSP’s involvement in treatment decision making. Results: Both a spouse/partner and another family member were very important in treatment decision-making for 33% of patients; a spouse/partner alone was very important for 19%; a family member alone was very important for 13%. A spouse/partner or friends were not important in treatment decision making for 24% of patients. Only 19% of patients reported that a friend was very important in treatment decision making. Friends were much more frequently endorsed among patients with family involvement (45%) vs those without family involvement (5%). Latina patients significantly more often reported that the opinion of a family member was very important vs. other race/ethnic groups (71% vs. 39%, p&lt;0.001). Patients in the pilot study reported an average of 2.67 DSPs were involved in locoregional decision making (SD = 2.57 ) vs. an average of 0.8 (SD=1.03) for involvement in systemic treatment decision making. Conclusions: Many breast cancer patients rely on some informal decision support, but there is a very wide variation in the extent and nature of this support. Further work is needed to understand how to best incorporate DSPs into the treatment decision process. Additional findings will be presented to further describe the impact of informal treatment decision support for women with breast cancer.

Patient involvement in multidisciplinary treatment planning (MTP).

145 Background: Patient involvement in treatment decision-making has been well-studied. However, little is known about how patients are involved in the MTP process prior to their consideration of treatment options. Methods: An online survey was administered to 1,261 Commission on Cancer (CoC)-accredited programs to describe current MTP practice. Survey items addressed team structure and process, case presentation, and patient involvement. A total of 797 (63%) facilities responded. Multiple aspects of patient involvement focusing on the initial case presentation and post-meeting follow-up regarding information provision and communication are examined. Initial descriptive analyses are presented. Results: 97% of facilities reported patients are not invited to attend MTP meetings. Reasons for not inviting patients included: patients may find it overwhelming (62%), physicians not able to speak freely (58%), liability (43%) and privacy (42%) concerns. Of the facilities that do invite patients, 1/3 reported that patients often or always attend. Treatment recommendations from MTP meetings are shared with patients at 75% of facilities, 42% share treatment plans, and 28% give a meeting summary to patients. Nine percent of facilities do not give patients any information from the meeting. Prior to treatment, a written treatment plan is developed at 43% of facilities, and among these, 15% give the plan to patients. Regarding communication about MTP meetings, facilities reported pre-meeting discussions with attending physicians (95%) and patient navigators (21%). Post-meeting follow-up by 93% of facilities is usually done by physicians, 26% by patient navigators and 16% by PA/NPs, and 66% follow-up within 1 week. Conclusions: Initial findings suggest that even if facilities do not invite patients to MTP meetings, they engage patients in various ways at pre- and post-MTP meetings, providing information and having discussions. Physicians are integral in communicating with patients throughout the MTP process. Further study on the multiple facets of patient involvement in MTP is needed to better understand its influence on treatment decision-making.