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Doctors’ and Patients’ Preferences for Participation and Treatment in Curative Prostate Cancer Radiotherapy

Peep F.M. Stalmeier, Julia J. van Tol-Geerdink, Emile N.J.Th. van Lin, Erik Schimmel, Henk Huizenga, Willem A.J. van Daal, Jan-Willem Leer

From the Departments of Radiation Oncology and Medical Technology Assessment, Radboud University Nijmegen Medical Center, Nijmegen; and Arnhems Radiotherapeutic Institute, Arnhem, the Netherlands

Address reprint requests to Peep F.M. Stalmeier, PhD, Radboud University Nijmegen Medical Centre, MTA 138, PO Box 9101, 6500 HB Nijmegen, the Netherlands; e-mail: p.stalmeier{at}mta.umcn.nl

Purpose Physicians hold opinions about unvoiced patient preferences, so-called substitute preferences. We studied whether doctors can predict preferences of patients supported with a decision aid.

Methods A total of 150 patients with prostate cancer facing radiotherapy were included. After the initial consultation, without discussing any treatment choice, physicians gave substitute judgments for patients' decision-making and radiation dose preferences. Physicians knew that several weeks later, patients would be empowered by a decision aid supporting a choice between two radiation doses involving a trade-off between disease-free survival and adverse effects. Subsequently, patient preferences for decision making (whether or not they wanted to choose a radiation dose) and for treatment (low or high dose) were obtained. The chosen radiation dose actually was administered.

Results Of the patients studied, 79% chose a treatment; physicians believed that 66% of the patients wanted to choose. Agreement was poor (64%; = 0.13; P = .11), and was better as patients became more hopeful (odds ratio [OR] = 4.4 per unit; P = .001) and as physicians' experience increased (OR = 1.09 per year; P = .02). Twenty percent of physicians' preferences, 51% of physicians' substitute preferences, and 71% of patients' preferences favored the lower dose; agreement was again poor (70%; = 0.2; P = .03).

Conclusion Physicians had problems predicting the preferences of patients empowered with a decision aid. They slightly underestimated patients' decision-making preferences, and underestimated patients' preferences for the less toxic treatment. Counseling might be improved by first informing patients—possibly using a decision aid—before discussing patient preferences.

Supported in part by a grant from the Dutch Cancer Society, Amsterdam, the Netherlands (Project No. KUN 2001-2379 and KUN 2005-3457). The funding agreement ensured the authors' independence in designing the study, interpreting the data, and writing and publishing the report. P.F.M.S. and J.J.V.T.-G. are supported by the sponsor.

Presented at the 10th Biennial European Meeting of the Society for Medical Decision Making, June 11-13, 2006, Birmingham, United Kingdom.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical Trials Registry ISRCTN97145188.

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