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BMC Cancer
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making

Authors: S. Mokhles, J. J. M. E. Nuyttens, M. de Mol, J. G. J. V. Aerts, A. P. W. M. Maat, Ö. Birim, A. J. J. C. Bogers, J. J. M. Takkenberg

Published in: BMC Cancer | Issue 1/2018

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Abstract

Background

The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice.

Methods

Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1–5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire.

Results

In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making.

Conclusions

Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.
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Literature
1.
Vansteenkiste J, Crino L, Dooms C, Douillard JY, Faivre-Finn C, Lim E, Rocco G, Senan S, Van Schil P, Veronesi G, et al. 2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol. 2014;25(8):1462–74.CrossRefPubMed
2.
Mokhles S, Verstegen N, Maat AP, Birim O, Bogers AJ, Mokhles MM, Lagerwaard FJ, Senan S, Takkenberg JJ. Comparison of clinical outcome of stage I non-small cell lung cancer treated surgically or with stereotactic radiotherapy: results from propensity score analysis. Lung Cancer. 2015;87(3):283–9.CrossRefPubMed
3.
Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, Groen HJM, McRae SE, Widder J, Feng L, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16(6):630–7.CrossRefPubMedPubMedCentral
4.
Solda F, Lodge M, Ashley S, Whitington A, Goldstraw P, Brada M. Stereotactic radiotherapy (SABR) for the treatment of primary non-small cell lung cancer; systematic review and comparison with a surgical cohort. Radiother Oncol. 2013;109(1):1–7.CrossRefPubMed
5.
Treasure T, Rintoul RC, Macbeth F. SABR in early operable lung cancer: time for evidence. Lancet Oncol. 2015;16(6):597–8.CrossRefPubMed
6.
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, Tomson D, Dodd C, Rollnick S, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.CrossRefPubMedPubMedCentral
7.
Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368(1):6–8.CrossRefPubMed
8.
Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267(16):2221–6.CrossRefPubMed
9.
10.
Fowler FJ Jr, Gallagher PM, Drake KM, Sepucha KR. Decision dissonance: evaluating an approach to measuring the quality of surgical decision making. Jt Comm J Qual Patient Saf. 2013;39(3):136–44.CrossRefPubMedPubMedCentral
11.
Ryan J, Sysko J. The contingency of patient preferences for involvement in health decision making. Health Care Manag Rev. 2007;32(1):30–6.CrossRef
12.
Murray E, Pollack L, White M, Lo B. Clinical decision-making: Patients’ preferences and experiences. Patient Educ Couns. 2007;65(2):189–96.CrossRefPubMed
13.
Gravel K, Legare F, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals’ perceptions. Implement Sci. 2006;1:16.CrossRefPubMedPubMedCentral
14.
Friedberg MW, Van Busum K, Wexler R, Bowen M, Schneider EC. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Aff (Millwood). 2013;32(2):268–75.CrossRef
15.
Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision making. JAMA. 2014;312(13):1295–6.CrossRefPubMed
16.
Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. 2014;94(3):291–309.CrossRefPubMed
17.
Mokhles S, Maat A, Aerts J, Nuyttens J, Bogers A, Takkenberg JJM. Opinions of lung cancer clinicians on shared decision making in early-stage non-small-cell lung cancerdagger. Interact Cardiovasc Thorac Surg. 2017;25:278–84.CrossRefPubMed
18.
Goldstraw P. IASLC staging manual in thoracic oncology. 1st ed. Orange Park: Editorial Rx Press; 2009.
19.
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–55.CrossRefPubMed
20.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed
21.
Nuyttens JJ, van de Pol M. The CyberKnife radiosurgery system for lung cancer. Expert Rev Med Devices. 2012;9(5):465–75.CrossRefPubMed
22.
Degner LF, Sloan JA, Venkatesh P. The control preferences scale. Can J Nurs Res. 1997;29(3):21–43.PubMed
23.
Salkeld G, Solomon M, Short L, Butow PN. A matter of trust—patient’s views on decision-making in colorectal cancer. Health Expect. 2004;7(2):104–14.CrossRefPubMedPubMedCentral
24.
Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol. 2004;22(15):3091–8.CrossRefPubMed
25.
Wallberg B, Michelson H, Nystedt M, Bolund C, Degner LF, Wilking N. Information needs and preferences for participation in treatment decisions among Swedish breast cancer patients. Acta Oncol. 2000;39(4):467–76.CrossRefPubMed
26.
Mallinger JB, Shields CG, Griggs JJ, Roscoe JA, Morrow GR, Rosenbluth RJ, Lord RS, Gross H. Stability of decisional role preference over the course of cancer therapy. Psychooncology. 2006;15(4):297–305.CrossRefPubMed
27.
O’Connor AM. Validation of a decisional conflict scale. Med Decis Mak. 1995;15(1):25–30.CrossRef
28.
Koedoot N, Molenaar S, Oosterveld P, Bakker P, de Graeff A, Nooy M, Varekamp I, de Haes H. The decisional conflict scale: further validation in two samples of Dutch oncology patients. Patient Educ Couns. 2001;45(3):187–93.CrossRefPubMed
29.
Rubin DB. Multiple imputation for non-response in surveys. New York: Wiley; 1997.
30.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.CrossRefPubMed
31.
Smith HJ, Taylor R, Mitchell A. A comparison of four quality of life instruments in cardiac patients: SF-36, QLI, QLMI, and SEIQoL. Heart. 2000;84(4):390–4.CrossRefPubMedPubMedCentral
32.
Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, Sprangers MA, te Velde A, Verrips E. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998;51(11):1055–68.CrossRefPubMed
33.
34.
Coste J, Quinquis L, Audureau E, Pouchot J. Non response, incomplete and inconsistent responses to self-administered health-related quality of life measures in the general population: patterns, determinants and impact on the validity of estimates - a population-based study in France using the MOS SF-36. Health Qual Life Outcomes. 2013;11:44.CrossRefPubMedPubMedCentral
35.
Donington J, Ferguson M, Mazzone P, Handy J Jr, Schuchert M, Fernando H, Loo B Jr, Lanuti M, de Hoyos A, Detterbeck F, et al. American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest. 2012;142(6):1620–35.CrossRefPubMed
36.
Efron B. Better bootstrap confidence-intervals. J Am Stat Assoc. 1987;82(397):171–85.CrossRef
37.
Efron B. An introduction to the bootstrap method. New York: Chapmann and Hall/CRC; 1993.CrossRef
38.
39.
Jensen JD, Carcioppolo N, King AJ, Scherr CL, Jones CL, Niederdieppe J. The cancer information overload (CIO) scale: establishing predictive and discriminant validity. Patient Educ Couns. 2014;94(1):90–6.CrossRefPubMed
40.
Legare F, Ratte S, Stacey D, Kryworuchko J, Gravel K, Graham ID, Turcotte S. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2010;5:CD006732.
41.
Katz SJ, Belkora J, Elwyn G. Shared decision making for treatment of cancer: challenges and opportunities. J Oncol Pract. 2014;10(3):206–8.CrossRefPubMed
42.
Thorne S, Oliffe JL, Stajduhar KI. Communicating shared decision-making: cancer patient perspectives. Patient Educ Couns. 2013;90(3):291–6.CrossRefPubMed
43.
Katz SJ, Hawley ST. From policy to patients and back: surgical treatment decision making for patients with breast cancer. Health Aff (Millwood). 2007;26(3):761–9.CrossRef
44.
Bickell NA, Weidmann J, Fei K, Lin JJ, Leventhal H. Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust. J Clin Oncol. 2009;27(31):5160–7.CrossRefPubMedPubMedCentral
45.
46.
Weeks JC, Cook EF, O’Day SJ, Petersen LM, Wenger N, Reding D, Harrell FE, Kussin P, Dawson NV, Connors AF, et al. Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA. 1998;279(21):1709–14.CrossRefPubMed
47.
Reuben DB, Naeim A. Perspectives, preferences, care practices, and outcomes in late-stage cancer patients: connecting the dots. J Clin Oncol. 2004;22(24):4869–71.CrossRefPubMed
48.
Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL, Schrag D. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012;367(17):1616–25.CrossRefPubMedPubMedCentral
49.
Rosenberg SM, Tracy MS, Meyer ME, Sepucha K, Gelber S, Hirshfield-Bartek J, Troyan S, Morrow M, Schapira L, Come SE, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159(6):373–81.CrossRefPubMedPubMedCentral
50.
Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. Patient Educ Couns. 2012;86(1):9–18.CrossRefPubMed
51.
O’Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2009;3:CD001431.
52.
Elwyn G, O’Connor AM, Bennett C, Newcombe RG, Politi M, Durand MA, Drake E, Joseph-Williams N, Khangura S, Saarimaki A, et al. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS One. 2009;4(3):e4705.CrossRefPubMedPubMedCentral
53.
Sim JA, Shin JS, Park SM, Chang YJ, Shin A, Noh DY, Han W, Yang HK, Lee HJ, Kim YW, et al. Association between information provision and decisional conflict in cancer patients. Ann Oncol. 2015;26(9):1974–80.CrossRefPubMed
54.
Taylor BA, Hart RD, Rigby MH, Trites J, Taylor SM, Hong P. Decisional conflict in patients considering diagnostic thyroidectomy with indeterminate fine needle aspirate cytopathology. J Otolaryngol Head Neck Surg. 2016;45:16.CrossRefPubMedPubMedCentral
55.
Hope S, Williams AE, Lunn D. Information provision to cancer patients: a practical example of identifying the need for changes in practice from the Dorset cancer Centre. Eur J Cancer Care (Engl). 2000;9(4):238–42.CrossRef
56.
Mokhles S, Nuyttens JJ, Maat AP, Birim O, Aerts JG, Bogers AJ, Takkenberg JJ. Survival and treatment of non-small cell lung cancer stage I-II treated surgically or with stereotactic body radiotherapy: patient and tumor-specific factors affect the prognosis. Ann Surg Oncol. 2015;22(1):316–23.CrossRefPubMed
57.
Janis IL. Decision making:a psycological analysis of conflict, choice, and commitment. New York: Free Press; 1977.
58.
Poghosyan H, Sheldon LK, Leveille SG, Cooley ME. Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: a systematic review. Lung Cancer. 2013;81(1):11–26.CrossRefPubMed
59.
60.
Kashaf MS, McGill E. Does shared decision making in cancer treatment improve quality of life? A systematic literature review. Med Decis Mak. 2015;35(8):1037–48.CrossRef
Metadata
Title
Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making
Authors
S. Mokhles
J. J. M. E. Nuyttens
M. de Mol
J. G. J. V. Aerts
A. P. W. M. Maat
Ö. Birim
A. J. J. C. Bogers
J. J. M. Takkenberg
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-3986-5

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