For patients with cancer, management decisions have to consider the quality of survival as well as the prolongation of life. Choices about treatment are often particularly stark. Participation in decision-making helps adaptation to illness, increases satisfaction with medical care and promotes acceptance of treatment. But, for some patients, it may impose undue responsibility, cause confusion, heighten anxiety or undermine trust in the doctor. The Drug and Therapeutics Bulletin reviewed the literature on where the balance lies.
- In the U.S.A. and the United Kingdom, 90% of patients want to know exact details of their illness and treatment.
- Up to 80% of patients want an active role in decisions about their cancer treatment. Younger, better educated and female patients are more likely to participate in decision-making. Few want to take sole responsibility.
- Shared responsibility for treatment decisions reduces psychological disturbance.
- Patients need information about the illness, proposed treatment and adverse effects.
- Effects of treatment on work and family cause as much distress as physical effects.
- Patients under stress recall little of the medical interview. Medical jargon and basic failures in communication make the patient's task harder. Written information or audio tapes of the consultation help.
- Patients' choices are strongly influenced by their perception of what the doctors want them to do, but doctors' recommendations are often biased in a variety of ways.
- Information from several sources, second opinions and counsellors may be necessary.
Most patients with cancer wish to be fully informed about their disease and its treatment. Such involvement appears to help psychological well-being. Good communication is necessary even when decisions are left to the doctor.