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Palliative Chemotherapy or Watchful Waiting? A Vignettes Study Among Oncologists

From the Department of Medical Psychology, Internal Medicine, Clinical Epidemiology, and Biostatistics, Academic Medical Center, University of Amsterdam, and Department of Internal Medicine, University Medical Center, Amsterdam, the Netherlands.

Address reprint requests to CG Koedoot, MA, Academic Medical Center, Department of Medical Psychology, PO Box 22700, 1100 DE Amsterdam, the Netherlands; email: c.g.koedoot{at}amc.uva.nl

PURPOSE: To determine the preferences of oncologists for palliative chemotherapy or watchful waiting and the factors considered important to that preference.

METHODS: Sixteen vignettes (paper case descriptions), varying on eight patient and treatment characteristics, were designed to assess the oncologists’ preferences. Their strength of preference was rated on a 7-point scale. An orthogonal main effects design provided a subset of all possible combinations of the characteristics, allowing estimations of the relative weights of the presented characteristics. A written questionnaire was sent to a random sample of oncologists (N = 1,235).

RESULTS: The response rate was 67%, and 697 questionnaires were available for analysis. Eighty-one percent of the respondents were male. The mean age was 46 years. We found considerable variation among the oncologists. No major associations between physician characteristics and preferences were found. Of the patient and treatment characteristics affecting treatment preference, age was the strongest predictor, followed by the patient’s wish to be treated and the expected survival gain. Other patient and treatment characteristics had a limited effect on preferences, except for psychologic distress, which had no independent impact.

CONCLUSION: Patients will encounter different decisions depending on their oncologists’ preferences and their own personal background. Therefore, to ensure adequate information for decision-making processes, decision aids are proposed.

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