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BOSTON – To increase patient satisfaction with the care they provide, physicians should share decisions about treatment, even if the patients insist they prefer the clinician to call the shots.
That’s according to a recent study published online recently by JAMA Oncology, which found that patients who recounted physician-controlled decisions about their cancer care were less likely than those participating in shared decision-making to report that they received excellent quality of care.
Background information in the article notes that, while metrics of quality are controversial, patients' reports about the quality of their care are increasingly important healthcare performance measures.
The study, conducted by a team led by Harvard Medical School researchers, is based on a survey of patients in the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study. Responses from 5,315 patients with lung and/or colorectal cancer – who reported roles for 10,817 treatment decisions – were analyzed to assess the association between variations in decision making and reported quality of care and physician communication.
Study participants were faced with decisions regarding surgery (42%), chemotherapy (36%) and radiation therapy (22%).
The survey indicated that the majority, 58%, of patients preferred shared roles in decision-making about their cancer, and 36% preferred patient-controlled decisions. Only 6% said they preferred physician-controlled decisions.
In terms of actual decision making about cancer treatment, however, 44% were shared, 39% were patient-controlled and 17% were physician-controlled, according to the study.
Overall, patients rated their treatment as excellent in 67.8% of cases, but patient reports that treatment decisions were controlled by physicians – as opposed to shared – were linked to lower odds of receiving excellent patient-reported quality, 59.7% vs. 69.5%. Those differences held up even when patients had expressed a preference for physician decision making.
In terms of communications, only 43.7% of patients gave physicians the highest rating when the provider made decisions about care instead of sharing the process. That’s compared to 57.9% with shared decision making and 57.4 when the patient was the decider.
"Given the increasing emphasis on patient experiences and ratings in health care, these results highlight the benefits of promoting shared decision making among all patients with cancer, even those who express preferences for less active roles," the study concludes.
In a related commentary, Sarah T. Hawley, PhD, MPH, and Reshma Jagsi, MD, D.Phil, of the University of Michigan, make note of the association shown between shared decision making and patient appraisal of excellent quality of care.
“It is intriguing that this association remained even when controlling for preferred role.”
The commentators say they were not surprised, however, that "patients who preferred a physician-controlled decision rated the physician communication outcomes highest when the actual decision-making process was more shared, as the individual items that constitute the communication measure described elements most likely to be absent when the actual decision is not shared.”