Why do some patients prefer to leave decisions up to the doctor: lack of self-efficacy or a matter of trust?
- 1.1k Downloads
Decision-making preferences among cancer survivors during their follow-up care remains understudied and limited research examines factors that underlie these preferences. The purpose of this study was to assess cancer patients’ decision-making preferences during follow-up care, the role of trust and self-efficacy, and the effect of preferences on health outcomes.
Six hundred twenty-three bladder, leukemia, and colorectal cancer survivors were recruited to the Assessment of Patient Experiences of Cancer Care study between April 2003 and November 2004. Respondents were asked about their follow-up care experiences, including decision-making preferences, trust in physicians, self-efficacy, health-related quality of life (HRQOL), and health appraisal. Unadjusted mean scores of trust and self-efficacy measures by decision preference group were examined. Multinomial logistic and linear regressions were conducted to examine predictors of decision-making preferences and the impact of decision-making preferences on HRQOL and health appraisal.
While the majority of patients preferred shared decision-making (61.0 %), 16.1 % preferred to control their decisions and 22.1 % preferred physician control over decisions. Compared to the other groups, patients preferring physician control had greater trust in their physician (p < 0.001), similar self-efficacy for engaging in the decision-making process, and lower self-efficacy for taking responsibility over decisions (p < 0.001). There were no notable differences between decision-making groups on outcome measures.
Patients who prefer physicians to control decisions are as confident about participating in the decision-making process and experience similar health outcomes as those preferring greater decisional control. Physicians need to tailor their communication behavior to encourage participation and trust among all patients.
Implications for Cancer Survivors
Findings from this study provide unique insights into the decision-making preferences of cancer patients during receipt of follow-up care, which remains an understudied phase of cancer care delivery. Results underscore the need for approaches to decision-making and patient engagement to become more nuanced and to encourage patients to participate in decision-making in ways they are most comfortable. Furthermore, physicians and health care professionals should foster environments that promote trust and clear communication regardless of patient decision-making styles.
KeywordsCancer Patient preferences Patient decision support Patient–provider communication
This paper reflects the personal opinions of Dr. Chawla and Dr. Arora and does not convey any official position of the National Cancer Institute. Funding for data collection was provided by the National Cancer Institute as a contract to the Cancer Prevention Institute of California (formerly known as the Northern California Cancer Center), contract no. N01-PC-35136. Findings from this study were presented at Academy Health Annual Research Meeting, June 24–26, 2012, Orlando, FL, USA. The authors would like to acknowledge the Dr. Ingrid Oakley-Girvan for her data collection efforts for this study.
- 5.Epstein RM, Street Jr RL. Patient-centered communication in cancer care: promoting healing and reducing suffering. Bethesda: National Cancer Institute of Medicine; 2007.Google Scholar
- 23.Institute of Medicine. Cancer care for the whole patient: meeting psychosocial health needs. Washington: National Academy Press; 2007.Google Scholar
- 31.Ware JJ, Kosinski M, Dewey J. How to score version 2 of the SF-361 health survey. Lincoln: QualityMetric Incorporated; 2000.Google Scholar
- 32.Ware JJ, Kosinski M, Gandek B. SF-36 health survey: manual and interpretation guide. Lincoln: QualityMetric Incorporated; 2000.Google Scholar
- 34.O’Brien MA, Ellis PM, Whelan TJ, Charles C, Gafni A, Lovrics P, Mukherjee SD, Hodgson N. Physician-related facilitators and barriers to patient involvement in treatment decision making in early stage breast cancer: perspectives of physicians and patients. Health Expect. 2011. doi: 10.1111/j.1369-7625.2011.00712.x.