Decision making during serious illness: what role do patients really want to play?
Level 4 - case-series / case-control
Cross-sectional survey comparing two distinct cohorts.
PubMed 1432023 · doi:10.1016/0895-4356(92)90110-9
What was done
Two cross-sectional surveys were conducted to evaluate preferred roles in cancer treatment decision-making. Participants included 436 newly diagnosed cancer patients and 482 members of the general public. Decision-making preferences among five potential roles were measured using two card-sort procedures.
What was found
Among cancer patients, 59% preferred that physicians make treatment decisions on their behalf, whereas 64% of the public stated they would want to select their own treatment if diagnosed with cancer. When faced with being too ill to participate directly, 51% of patients and 46% of the public preferred shared decision-making between their physician and family. Sociodemographic variables accounted for only 15% of the variance in role preferences.
Why it matters
This study shows that healthy individuals' hypothetical preferences differ substantially from the actual preferences of patients experiencing life-threatening illness, cautioning clinicians against assuming that public attitudes directly translate to clinical practice.
Limits
The abstract lacks details on recruitment methods, response rates, and specific clinical subgroups. The cross-sectional design compares different individuals rather than tracking changes within the same person over time. Sociodemographic variables explained very little variance (15%), leaving most factors influencing preference unidentified.
Cited by
- supports Roughly two-thirds of surveyed healthy people say they would want to choose their own cancer treatment if diagnosed, but only about 10% of actual cancer patients want that choice.