Shared decision-making improves patient satisfaction during radiation therapy

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Shared decision-making improves patient satisfaction during radiation therapy
Shared decision-making improves patient satisfaction during radiation therapy

Playing an active role in their radiation treatment decisions leaves patients with cancer feeling more satisfied with their care, and may even relieve psychologic distress around the experience, researchers reported.

In a study of 305 patients undergoing radiation treatment, Neha Vapiwala, MD, an associate professor in the department in Radiation Oncology at Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues found an association between patient satisfaction and patient-perceived control and shared decision making (SDM). SDM is a process that allows patients and providers to make health care decisions together, taking into account scientific evidence as well as the patient's values and preferences.

Patients who experienced SDM or perceived some control over their treatments were more satisfied with their care than were those who did not experience SDM or perception of control—a difference of almost 17% and 26%, respectively. Furthermore, increased anxiety, depression, and fatigue were reported in patients who desired control over treatments but did not perceive this control.

"Most importantly, our findings emphasize the value of patient-physician relationships and communication specifically in radiation oncology, and their impact on patient experience in a way that hasn't been shown before," said Vapiwala. "No matter where cancer patients are in the treatment process, there is always an opportunity to improve patient satisfaction—something hospitals and providers have consciously and increasingly been making a priority."

Past studies of SDM in patients undergoing chemotherapy, as well as treatments for other medical conditions such as hypertension and diabetes, have shown an association with improved satisfaction and quality of life. Taking notice, the Institute of Medicine recently recognized its importance, and the Affordable Care Act even devotes an entire section to establishing a program for SDM. However, no group has evaluated its impact on patients going through radiation.

Often, radiation oncology is seen as a treatment avenue that is ultimately left to the physician to dictate. But there are tailored options, decisions, and discussions that can apply to individual patients, even if they all have similar diagnoses. There are different radiation regimens, dosages, risks and benefits, as well as pain control management issues, which should be part of the ongoing conversation.

Among the participants in the study, 31% of patients experienced SDM, 32% perceived control in decisions, and 76% reported feeling very satisfied with their radiation treatment course overall. A significant association was noted between patient satisfaction with his/her radiation treatments and patient-perceived experience of SDM (84.4% vs. 71.4%) or perceived control over one's treatment (89.7% vs. 69.2%). The study was published in Cancer (doi:10.1002/cncr.28665).

"As providers, it doesn't matter what treatment you are offering, or how complicated it is, or how busy you may be," said Vapiwala. "It's worth taking even a few minutes to talk to patients about seemingly minor decisions in which they can provide some input. It's not only critical in today's health care setting where both information and misinformation are rampant, but will very likely lead to the patient feeling positively about the encounter."

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