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Shared decision-making in palliative cancer care : a life span perspective

Groot Kormelinck, C.M. (2015) Shared decision-making in palliative cancer care : a life span perspective.

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Abstract:Background: Shared decision-making (SDM) is advocated in particular towards 1) elderly cancer patients, since treatment strategy depends on individual patient characteristics and preferences, and 2) in a palliative setting, where medical decision-making (MDM) involves a trade-off between quantity / quality of life. However, the MDM process in older cancer patients is not clearly understood and knowledge is scarce with regards to the feasibility of SDM in palliative cancer care. Moreover, studies suggest age-based differences in patients’ level of involvement in MDM, yet it remains unclear how age affects the MDM process. Aim: This study assesses the influence of age on patients preferences, perceived participation and levels of concordance (match between preferences and perceived participation) in MDM. Age-related aspects and demographics are explored as correlates. A life span perspective is used to study similarities / differences across three age groups, being ‘middle aged-’ (40-64 years), ‘young elderly-’ (65-74 years) and ‘old elderly’ (> 75 years) patients facing metastatic cancers, who have chosen whether or not to pursue (life-prolonging) chemotherapy. Method: The study design is quantitative, cross-sectional and retrospective. A paper and pencil questionnaire assessed (among others) patients’ health-related quality of life, self-efficacy in communicating with oncologists’, loneliness and temporal perspective as possible correlates towards participation in MDM. Results: Patients’ preferred-, perceived participation roles and levels of concordance were not age-related. A striking majority of both ‘young-’ and ‘old elderly’ patients preferred a patient centered approach and a majority of all age groups perceived the MDM as patient centered. Almost 20% of the patients was less involved than preferred in MDM. ‘Old elderly’ patients were significantly less encouraged to talk about worries as compared to ‘middle aged’ patients. Perceived SDM was associated with higher levels of self-efficacy in communication with oncologists and female gender. Discussion: No evidence was found for age-related differences with regards to participation in MDM, probably due to the palliative nature of this study. If clinical practice aims to fit preferences better towards actual involvement, patients preferences should be literally asked for by oncologists, so that each can achieve their preferred level of involvement and treatments are tailored with respect to patient characteristics and preferences.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
Link to this item:http://purl.utwente.nl/essays/69385
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