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Discordance Between Advanced Cancer Patients’ Perceived and Preferred Roles in Decision Making and its Association with Psychological Distress and Perceived Quality of Care

Author

Listed:
  • Semra Ozdemir

    (Duke-NUS Medical School
    National University of Singapore)

  • Yubing Tian

    (Duke-NUS Medical School)

  • Chetna Malhotra

    (Duke-NUS Medical School)

  • Richard Harding

    (Cicely Saunders Institute of Palliative Care, King’s College London)

  • Gerald Choon Huat Koh

    (National University of Singapore)

  • Nesaretnam Barr Kumarakulasinghe

    (National University Cancer Institute)

  • Lai Heng Lee

    (SingHealth Duke-NUS Blood Cancer Centre, Singapore General Hospital)

  • Ssu Wynn Mon

    (Department of Medical Research)

  • Eric Finkelstein

    (Duke-NUS Medical School
    National University of Singapore
    Duke University Global Health Institute)

Abstract

Objective We investigated patient-reported roles of families, physicians, and patients themselves in treatment decision making and whether discordance between perceived and preferred roles is associated with psychological distress and perceived quality of care among patients with cancer. Methods We analyzed cross-sectional survey data from 599 adults with stage IV solid malignancy in Singapore. Stuart-Maxwell tests were used to compare patients’ perceived and preferred roles in decision making. Types of discordance were categorized as follows: involvement at a lesser level than preferred, involvement at a greater level than preferred, and no change in patient involvement. Ordinary least squares regressions examined the associations between types of discordance and patient outcomes, controlling for patient characteristics. Results Discordance between perceived and preferred roles was observed in 16% of patients. Amongst patients with discordance, 33% reported being involved at a lesser level than they preferred, 47% reported being involved at a greater level than they preferred, and 19% reported discordance where level of patient involvement did not change. Multivariable analyses showed that lesser involvement than preferred and discordance with no change in patient involvement were associated with poorer quality of physician communication (β = − 9.478 [95% confidence interval {CI} − 16.303 to − 2.653] and β = − 9.184 [95% CI − 18.066 to − 0.301]) and poorer care coordination (β = − 11.658 [95% CI − 17.718 to − 5.597] and β = − 8.856 [95% CI − 16.744 to − 0.968]) compared with concordance. Conclusions Most patients reported participating at their desired level. Despite this finding, our results suggest that involving patients at a lesser level than they prefer can lead to poorer perceived quality of physician communication and care coordination and that encouraging patient participation is a safe approach to minimizing poor outcomes.

Suggested Citation

  • Semra Ozdemir & Yubing Tian & Chetna Malhotra & Richard Harding & Gerald Choon Huat Koh & Nesaretnam Barr Kumarakulasinghe & Lai Heng Lee & Ssu Wynn Mon & Eric Finkelstein, 2021. "Discordance Between Advanced Cancer Patients’ Perceived and Preferred Roles in Decision Making and its Association with Psychological Distress and Perceived Quality of Care," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 14(5), pages 581-589, September.
  • Handle: RePEc:spr:patien:v:14:y:2021:i:5:d:10.1007_s40271-020-00480-1
    DOI: 10.1007/s40271-020-00480-1
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