A. De Roo1, M. Miller2, A. Antunez1, C. Kin2, A. Morris2 1University Of Michigan,General Surgery,Ann Arbor, MI, USA 2Stanford University,General Surgery,Palo Alto, CA, USA
Introduction: Collaborative decision making (DM) between patients and physicians is an essential feature of patient centered care. Patient DM roles are categorized as (1) active or patient-driven; (2) collaborative, in which the patient and physician together form a treatment plan; and (3) passive or physician-driven. We hypothesized that lower socioeconomic status and minority ethnicity are associated with a more passive role in cancer care DM.
Methods: To investigate preferred and actual DM roles for cancer care, we performed a systematic review of the literature in 5 databases. The search string encompassed “decision making”, “cancer care” and “socioeconomic status” and was limited to English language articles published between 2006-16. One reviewer assessed 1454 abstracts and excluded 1375 that did not pertain to cancer treatment, adult patients, primary data, or peer review. The remaining 79 articles were reviewed in full by >= 2 study team members to verify final eligibility: comparison of preferred or actual DM role among two or more socioeconomic groups or ethnicities. We developed a data abstraction tool to capture study features, population, methods, results, conclusions, and methodological quality. Data from quantitative and qualitative articles were integrated through constant comparison across a joint display table and triangulated through iterative discussion among the team.
Results: 24 quantitative, 2 mixed methods, and 6 qualitative studies met inclusion criteria. Among most studies, older age, low health literacy and low income were associated with a more passive role in DM. Low-acculturated Latina women were more likely to report poor understanding of treatment options and, consequently, to prefer a more passive DM role. They were also less likely to be satisfied with DM role and with care when they did not understand the rationale for the treatment decision. In contrast, high-acculturated American Latina women were more active decision makers, as were younger patients and those with breast cancer. Although lower satisfaction scores were noted in patients from minority populations or with low health literacy, American Indians and African Americans indicated that trust and being treated with respect were associated with DM role satisfaction and adherence to therapy.
Conclusion: Patients with lower health literacy, socioeconomic status or non-majority demographics were more likely to play a passive role in cancer treatment decision making, which was associated with lower satisfaction especially if they did not understand the rationale for treatment decisions. Improved patient education materials and interactions for a variety of languages and health literacy levels will allow these patients participate as desired in their cancer treatment choices. With the information gained from this study, care provider training and patient education materials can be adjusted to allow for greater patient collaboration in decision making.