Treatment decision making in metastatic prostate cancer (mPC).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 224-224
Author(s):  
Alicia K. Morgans ◽  
Angela Fought ◽  
Benjamin Lee ◽  
David James VanderWeele ◽  
Maha H. A. Hussain ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Good Health ◽  
Clinical Encounter ◽  
Treatment Choice ◽  
Categorical Variables ◽  
Exact Test ◽  
Treatment Decision Making ◽  
High Level ◽  
The Relationship

224 Background: Multiple treatments exist for mPC, and optimal treatment choice is not defined. Shared decision making (SDM) in which physicians communicate treatment purpose, risks, and benefits, and patients (pts) communicate values/preferences can be used to determine treatment. SDM is associated with superior health outcomes in non-cancer populations, but whether it is used in mPC is unknown. We assessed mPC pt and caregiver perceptions of decision locus of control (DLOC) (SDM vs physician (PD) or pt (PtD) directed decisions), and characteristics associated with DLOC. Methods: Between 12/16 and 11/17, mPC patients and caregivers completed surveys of decision making practices after a clinical encounter in which a decision occurred. To evaluate the relationship between pt perception of DLOC type and categorical variables we used Fisher’s exact test, and Kruskal-Wallis was used to evaluate the relationship between DLOC and age. Results: 50 pt/caregivers participated, with median pt age of 72 yo. Most pts were Caucasian (96%), married (90%), and reported good health or better (18% excellent, 58% good, 24% fair). 66% of pts reported SDM, 10% reported PD only, 12% reported PD considering patient’s preferences, and 12% reported PtD considering physician’s recommendation. Caregivers reported numerically lower rates of SDM (56%), PD only (6%), and PD considering patient’s preferences (8%), but greater PtD considering physician’s recommendation (30%), (p=0.28). Neither reported PtD without considering physician recommendations. There was no association between pt DLCO and age (p=0.70) or clinician type, (p=0.13). All pts reporting PtD considering physician’s recommendation saw medical oncologists rather than urologists. Conclusions: Both pts and caregivers perceived a majority of decisions as SDM, indicating a high level of patient engagement in mPC decision making, and clinician type and patient age were not associated with pt reported DLOC. Pts seen by medical oncology in this cohort reported directing treatment choice when considering physician’s recommendation. Efforts to assess and support decision making in more diverse patient populations and explore the association between SDM, pt satisfaction and quality of life are underway.

scholarly journals Computer knows best? The need for value-flexibility in medical AI

2018 ◽  
Vol 45 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Rosalind J McDougall
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Value Judgements ◽  
The Relationship

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making.

Shared decision-making, decision aids, and the role of values in treatment decision-making

2017 ◽  
Author(s):  
Amiram Gafni ◽  
Cathy Charles
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Conceptual Development ◽  
Decision Aids ◽  
Treatment Decision ◽  
Clinical Encounter ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Key Characteristics

Shared decision-making (SDM) between physicians and patients is often advocated as the ‘best’ approach to treatment decision-making in the clinical encounter. In this chapter we describe: (i) the key characteristics of a SDM approach; (ii) the clinical contexts for SDM; (iii) the definition and use of decision aids (DA), as well as their relationship to SDM; and (iv) the vexing problem of defining the meaning and role of values/preferences in treatment decision-making. Areas for further research and conceptual development are also suggested to help resolve outstanding issues in the above areas. Despite the widespread interest in promoting SDM, there does not seem to be as yet a universally accepted consensus on the meaning of this concept.

scholarly journals Communication in the Clinical Encounter: Dealing with the Disparities

2016 ◽  
Vol 20 (1) ◽  
pp. 19 ◽  
Author(s):  
Adnan Pirbhai
Keyword(s):  
Decision Making ◽  
Western Medicine ◽  
Life Experience ◽  
Treatment Decision ◽  
Clinical Encounter ◽  
Explanatory Models ◽  
Medical Community ◽  
Subjective Response ◽  
Treatment Decision Making ◽  
Decision Making Model

Despite basing its foundation upon the ideals of Hippocrates, Western medicine, especially in the last century, has shifted from a holistic to a more reductionist approach to understanding and treating patients. These changes are primarily a result of widespread acceptance of the biomedical model in modern medicine. Consequently, there are now significant differences in physician and patient explanatory models for the same ailment. Cancer, for example, is interpreted as primarily a physiological process by the medical community, or more simply, as a disease. The patient, on the other hand, interprets cancer as an illness, a more subjective response, covering all aspects of the patient’s life experience, including emotional, psychological, social, and cultural realms, in addition to physiological aspects. These differences in explanatory models result in disparities between physicians and patients when it comes to defining the condition, managing the condition and even defining successful outcomes. These incongruencies must be addressed through effective communication in the clinical encounter, an aspect of patient care that has proven beneficial effects on patient health outcomes. The shared treatment decision-making model best addresses these communication problems. By providing a framework for both the physician and patient to negotiate their respective explanatory models en route to a mutually agreeable treatment decision, this model is a compromise between the two extremes of patient-physician models of communication: paternalism andinformed decision-making. Ultimately, the shared treatment decision-making model establishes a clinical relationship that is no longer characterized by an inabilityto effectively negotiate and consolidate differing values due to unbalanced informational and power dynamics in a social context. By incorporating this model of communication into medical practice, physicians and patients will better understand each other, bridging the disparities apparent in current practice and allow Western medicine to once again approximate the Hippocratic ideal.

scholarly journals Influence of Men’s Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Elyse Reamer ◽  
Felix Yang ◽  
Margaret Holmes-Rovner ◽  
Joe Liu ◽  
Jinping Xu
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Population Based ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
Curative Treatment ◽  
Risk Level ◽  
Treatment Decision Making ◽  
Choice Decision

Background. Optimal treatment for localized prostate cancer (LPC) is controversial. We assessed the effects of personality, specialists seen, and involvement of spouse, family, or friends on treatment decision/decision-making qualities. Methods. We surveyed a population-based sample of men ≤ 75 years with newly diagnosed LPC about treatment choice, reasons for the choice, decision-making difficulty, satisfaction, and regret. Results. Of 160 men (71 black, 89 white), with a mean age of 61 (±7.3) years, 59% chose surgery, 31% chose radiation, and 10% chose active surveillance (AS)/watchful waiting (WW). Adjusting for age, race, comorbidity, tumor risk level, and treatment status, men who consulted friends during decision-making were more likely to choose curative treatment (radiation or surgery) than WW/AS (OR = 11.1, p<0.01; 8.7, p<0.01). Men who saw a radiation oncologist in addition to a urologist were more likely to choose radiation than surgery (OR = 6.0, p=0.04). Men who consulted family or friends (OR = 2.6, p<0.01; 3.7, p<0.01) experienced greater decision-making difficulty. No personality traits (pessimism, optimism, or faith) were associated with treatment choice/decision-making quality measures. Conclusions. In addition to specialist seen, consulting friends increased men’s likelihood of choosing curative treatment. Consulting family or friends increased decision-making difficulty.

Treatment Decision Making in Early-Stage Breast Cancer: Should Surgeons Match Patients’ Desired Level of Involvement?

2002 ◽  
Vol 20 (6) ◽  
pp. 1473-1479 ◽  
Author(s):  
Nancy L. Keating ◽  
Edward Guadagnoli ◽  
Mary Beth Landrum ◽  
Catherine Borbas ◽  
Jane C. Weeks
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Treatment Decision ◽  
Active Role ◽  
Breast Conserving Surgery ◽  
Treatment Choice ◽  
Early Stage Breast Cancer ◽  
Treatment Decision Making ◽  
Actual Role

PURPOSE: To describe desired and actual roles in treatment decision making among patients with early-stage breast cancer, identify how often patients’ actual roles matched their desired roles, and examine whether matching of actual and desired roles was associated with type of treatment received and satisfaction. PATIENTS AND METHODS: We surveyed 1,081 women (response, 70%) diagnosed with early-stage breast cancer in Massachusetts or Minnesota about their desired and actual roles in treatment decision making with their surgeon and used logistic regression to assess whether matching of actual to desired roles was associated with type of surgery and satisfaction. RESULTS: Most patients (64%) desired a collaborative role in decision making, but only 33% reported actually having such a collaborative role when they discussed treatments with their surgeons. Overall, 49% of women reported an actual role that matched the desired role they reported, 25% had a less active role than desired, and 26% had a more active role than desired. In adjusted analyses, patients whose reported actual role matched their desired role were no more likely than others to undergo breast-conserving surgery (P > .2), but these women were more satisfied with their treatment choice (83.5% very satisfied; reference) than those whose role was less active than desired (72.9% very satisfied; P = .02) or more active than desired (72.2% very satisfied; P = .005). CONCLUSION: Only approximately half of patients reported an actual role in decision making that matched the desired role they reported. These patients were more satisfied with their treatment choice than other patients, suggesting that women with early-stage breast cancer may benefit from surgeons’ efforts to identify their preferences for participation in decisions and tailor the decision-making process to them.

scholarly journals Treatment decision-making in men with localized prostate cancer living in remote area: A cross-sectional observational study

2020 ◽  
Vol 15 (3) ◽  
Author(s):  
Abir El-Haouly ◽  
Alice Dragomir ◽  
Hares El-Rami ◽  
Frédéric Liandier ◽  
Anaïs Lacasse
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Multiple Logistic Regression Analysis ◽  
Treatment Decision ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
Cancer Stage ◽  
Cross Sectional ◽  
Remote Areas ◽  
Treatment Decision Making

Introduction: For the management of localized prostate cancer, patient treatment choice is poorly documented among people living in remote areas where access to certain treatments offered in large centres involves travelling several hundred kilometres. This study aimed to describe and identify the determinants of treatment decision-making in men with localized prostate cancer living in remote areas. Methods: In this cross-sectional study, patients with prostate cancer were recruited from Rouyn-Noranda’s urology clinic (Quebec, Canada) between 2017 and 2019. Results: A total of 127 men (mean age 68.34±7.23 years) constituted the study sample. Radiotherapy, a treatment not available locally, was chosen most frequently (67.7%), followed by options available locally, such as surgery (22.8%) and active surveillance (9.4%). Most patients preferred to play an active role in this choice (53.5%) and agreed with the statement, “I chose that treatment because it gives the best chance for a cure” (86.6%). Multiple logistic regression analysis revealed that cancer stage (odds ratio [OR] 10.15; 95% confidence interval [CI] 3.18–32.40) was the only factor associated with radiotherapy choice (patients with lower stage cancer were more likely to choose radiotherapy). The socioeconomic status was not associated with treatment choice. Conclusions: While radiotherapy was not available locally, it was the most frequently chosen treatment, even though the available literature suggests that no one treatment option is superior in terms of cancer control. The choice of radiotherapy is not associated with patient income, but rather the cancer stage. This result could be explained by the patients’ desire to avoid surgery and its adverse effects.

Comparability of health-related quality of life (HRQOL), treatment decision making, and treatment satisfaction after PSA recurrence among prostate cancer patients who receive hormone therapy (HT) versus observation (OBS): Results from the COMPARE registry

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5131-5131
Author(s):  
T. Luu ◽  
O. Sartor ◽  
N. Dandade ◽  
S. Halabi ◽  
C. Bennett
Keyword(s):  
Decision Making ◽  
Sexual Dysfunction ◽  
Treatment Satisfaction ◽  
Hot Flashes ◽  
Treatment Decision ◽  
Treatment Choice ◽  
External Beam Radiation ◽  
Treatment Decision Making ◽  
Psa Failure ◽  
Patient Reported

5131 Background: HT may lower PSA, but it may also cause hot flashes and sexual dysfunction. OBS is not associated with hot flashes or lower testosterone production, but PSA may rise. Examining patient satisfaction with treatment decision making, treatment choice, and HRQOL may help improve disease management. We compared treatment satisfaction and HRQOL of patients who chose OBS over HT. Methods: The Comprehensive Multicenter Prostate Adenocarcinoma Registry (COMPARE) is an observational registry of men with PSA failure. Data from patient-reported questionnaires were analyzed for patients treated with OBS or HT. Results: 674 patients (82%) chose OBS; 147 (18%) chose HT. The median time between cancer diagnosis and registry enrollment was 6 years. Of men on OBS, 85%, 83%, and 71% were satisfied with treatment decision process, treatment choice, and treatment outcome, respectively. Men on HT had similar rates of satisfaction (82%, 75%, and 71%). Men initially treated with brachytherapy/surgery were less satisfied with OBS. Men initially treated with external beam radiation were less satisfied with HT. Patients reported similar problems with urinary, sexual, and bowel function. Conclusions: Men with PSA failure seem content with treatment choice and decision making and have low rates of urinary/bowel problems. Rates of sexual dysfunction in both groups are similar. Clinical trials may help determine if HT improves long-term outcomes (e.g. overall survival), since short-term patient reported satisfaction is similar between OBS and HT. The reported rate of sexual dysfunction is lower than expected. [Table: see text] [Table: see text]

A comparison of patient and physician attributes that promote patient involvement in treatment decision making in the oncology consultation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6098-6098
Author(s):  
P. M. Ellis ◽  
S. J. Dimitry ◽  
M. A. O’Brien ◽  
C. A. Charles ◽  
T. J. Whelan
Keyword(s):  
Decision Making ◽  
Information Seeking ◽  
Patient Involvement ◽  
Treatment Options ◽  
Treatment Decision ◽  
Skills Training ◽  
Structured Interviews ◽  
Treatment Decision Making ◽  
High Level ◽  
Level Of Agreement

6098 Background: Cancer patients have indicted a desire to be more involved in treatment decision making (TDM). However, little is known about the attributes of patients, physicians and their interaction that promotes patient involvement in TDM in the oncology consultation. This study compared attributes generated by patients and physicians that make it easier for patients to be involved in TDM. Methods: Semi-structured interviews were undertaken with 19 patients with cancer (lung, breast, prostate, GI) and 21 medical and radiation oncologists at a regional cancer centre. Participants were asked to identify attributes of physicians, patients and their interaction that promotes patient involvement in TDM. Interview transcripts were independently coded by 2 analysts using decision rules to identify specific attributes. Attributes identified by each analyst were compared and a high level of agreement was found. The analysts then independently compared the physician and patient generated lists and identified common vs unique items. There was a high level of agreement on which attributes were common to both lists versus unique. Results: Oncologists identified 173 physician, 59 patient and 9 interaction items. Patients identified 50 physician, 42 patient and 11 interaction items. Patients and physicians identified 17 common physician items, 29 common patients items and 1 common interaction item. Physicians identified 138 more attributes than patients, most of which were physician related. Common patient attributes centred on information seeking (eg prepare for the consultation by reading, be aware of all treatment options and question the options). Common physician attributes focused on specific communication behaviors (eg, make eye contact, tailor information to patient needs, be direct with patients, ensure patient understands information). The common interaction item was to keep the discussion informal. Conclusions: Patients and physicians appear to have different ideas about what is important to promote patient involvement in TDM. Many of the attributes identified can be easily incorporated into current practice. There is a need to develop and evaluate communication skills training to promote patient involvement in TDM. No significant financial relationships to disclose.

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