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Doctors' and patients' preferences for participation and treatment in curative prostate cancer radiotherapy.

Stalmeier PF, van Tol-Geerdink JJ, van Lin EN, Schimmel E, Huizenga H, van Daal WA, Leer JW

Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. p.stalmeier@mta.umcn.nl

PURPOSE: Physicians hold opinions about unvoiced patient preferences, so-called substitute preferences. We studied whether doctors can predict preferences of patients supported with a decision aid. METHODS: A total of 150 patients with prostate cancer facing radiotherapy were included. After the initial consultation, without discussing any treatment choice, physicians gave substitute judgments for patients' decision-making and radiation dose preferences. Physicians knew that several weeks later, patients would be empowered by a decision aid supporting a choice between two radiation doses involving a trade-off between disease-free survival and adverse effects. Subsequently, patient preferences for decision making (whether or not they wanted to choose a radiation dose) and for treatment (low or high dose) were obtained. The chosen radiation dose actually was administered. RESULTS: Of the patients studied, 79% chose a treatment; physicians believed that 66% of the patients wanted to choose. Agreement was poor (64%; = 0.13; P = .11), and was better as patients became more hopeful (odds ratio [OR] = 4.4 per unit; P = .001) and as physicians' experience increased (OR = 1.09 per year; P = .02). Twenty percent of physicians' preferences, 51% of physicians' substitute preferences, and 71% of patients' preferences favored the lower dose; agreement was again poor (70%; = 0.2; P = .03). CONCLUSION: Physicians had problems predicting the preferences of patients empowered with a decision aid. They slightly underestimated patients' decision-making preferences, and underestimated patients' preferences for the less toxic treatment. Counseling might be improved by first informing patients-possibly using a decision aid--before discussing patient preferences.

Published 19 July 2007 in J Clin Oncol, 25(21): 3096-100.
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