This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Stalmeier, P. F.M. Articles by Leer, J.-W. Search for Related Content PubMed PubMed Citation Articles by Stalmeier, P. F.M. Articles by Leer, J.-W.

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.