Shared Decision-Making in Lung Cancer Treatment: Patient Priorities and Preferences
Posted: Monday, April 1, 2019
Patients with early-stage lung cancer valued quality of life and maintenance of independence over survival or disease recurrence, according to research published in Lung Cancer. Among patients who received surgery or stereotactic body radiation therapy (SBRT), patient treatment preference was often discordant with the treatment prescribed.
“Understanding patients’ values and preferences regarding treatment decisions is essential to foster shared decision-making and ensure treatment plans are consistent with patients’ goals,” concluded Donald R. Sullivan, MD, of Oregon Health and Science University, Portland, and colleagues. “Clinicians need more resources to engage in high-quality communication during lung cancer treatment discussions.”
The multicenter study included 114 patients who were 4 to 6 months removed from treatment for stage I lung cancer. More participants reported quality of life or independence as their “most important” priority compared with overall or disease-free survival. Similarly, most participants (86%) reported valuing independence more than an extended lifespan, preferring a higher quality of life over receiving permanent nursing home care or being limited to a bed or chair for additional years. However, a majority of patients (83%) were willing to accept a high periprocedural mortality rate if the treatment provided them a 2% chance at a 1-year extension of life, emphasizing the preference for quality of life over overall survival.
Treatment discordance was more common than expected, with 49% of patients preferring the alternate treatment strategy to the one they received. A total of 60% of study participants had received SBRT, whereas 40% underwent surgery. Overall, the mean patient age was 70 years, with 65% of participants being men.
Disclosure: The study authors reported no conflicts of interest.