Physician-Controlled Cancer Care Decisions Get Lower Patient Quality Ratings

Study finds shared decision making and accommodation of patient preferences improves quality.

Shared decision making between patients and physicians in cancer care was more like to receive excellent quality of care ratings versus physician-controlled decisions, according to a study published online in Jama Oncology.

The study noted that quality metrics including patient reports about their care are becoming more prevalent in measuring health care performance. Additionally, The Institute of Medicine has stated that the accommodation of patient preferences can improve the overall quality of health care.

Researchers at Harvard Medical School surveyed 5315 patients in the Cancer Care Outcomes Research and Surveillance Consortium who were diagnosed with lung cancer and/or colorectal cancer. The survey included decision roles for 10,817 treatment decisions, which researchers utilized to evaluate the link between patient roles in decision making with the quality of care and physician communication that patients reported.

Fifty-eight percent of patients indicated a preference for shared decision-making roles concerning their cancer care, 36% said they prefer patient-controlled decisions, and 6% preferred physician-controlled decisions.

Concerning treatment decisions that were made by patients, 42% involved surgery, 36% involved chemotherapy, and 22% involved radiation therapy. Patients indicated that their actual decision-making process as patient-controlled in 39% of decisions, shared in 44% of decisions, and physician-controlled in 17% of decisions.

The study noted that 67.8% of patients reported care by the physician performing the treatment as excellent. While a patient's preferred decision-making role was not associated with quality ratings, reports of physician-controlled treatment decisions were associated with less odds of excellent patient-reported quality compared with shared decision making.

Furthermore, 55.8% of patients gave the highest possible communication rating to their physicians, but patients who preferred physician-controlled decisions were less likely to give high ratings to physicians. Patients who said they actually had experienced physician-controlled decisions versus shared decisions were also less likely to give the highest possible marks to physicians.

"Given the increasing emphasis on patient experiences and ratings in health care, these results highlight the benefits of promoting shared decision making among all patients with cancer, even those who express preferences for less active roles," the study authors concluded.

In an accompanying commentary, Sarah T. Hawley, PhD, MPH, and Reshma Jagsi, MD, DPhil, wrote that the results emphasize the need to better evaluate shared decision making as it relates to a patient’s assessment of their care.

"We find it unsurprising that even patients who preferred a physician-controlled decision rated the physician communication outcomes highest when the actual decision-making process was more shared, as the individual items that constitute the communication measure described elements most likely to be absent when the actual decision is not shared," the commentary noted.