free full access: Preferred and actual participation roles during health care decision making in persons with cancer: a systematic review University

Note: gynecologic cancers included as one cancer (not broken down in chart)

table 1:    Preferred role versus actual or perceived role in treatment decision making (list of studies)


table 2:   Summary range of patients’ preferred role versus actual role by cancer type (click on 'read more')

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conclusions:

The descriptive nature of the studies included in this review makes it very difficult to calculate the exact difference between preferred and actual roles in decision making; hence, the authors report a summary range. Nevertheless, despite the use of a summary range, it is still quite clear that there is a limited concordance between preferred and actual roles in decision making. This limited concordance between patients’ preferred and actual roles assumed during decision making has indicated that clinicians need to raise their sensitivity regarding patient's participation in health care decisions. Given the variability and dynamic nature of patients’ role preferences, an individual assessment should be carried out during the entire course of treatment planning, particularly each time a critical treatment decision is about to be made. There is a need for clinicians to improve their communication skills to promote a patient's willingness to share his/her needs and desires. Innovative intervention studies that can improve matching of patient's preferred and actual roles during decision making are warranted as are studies that examine clinicians’ views on patient participation in decision making. Research on how patient- and clinician-related characteristics affect treatment decisions (e.g. age, gender, race/ethnicity, education) is also needed to determine those factors that affect the actualization of patients’ preferred role.

Table 2.

Summary range of patients’ preferred role versus actual role by cancer type

Cancer type (N = 19 studies)	Preferred active role (%)	Actual active role (%)	Preferred shared role (%)	Actual shared role (%)	Preferred passive role (%)	Actual passive role (%)
Breast (11)	13–40.4	15.3–64.6	21–63.5	18–43.3	12.2–66	8.1–60.7
Prostate (4)	13.3–55.8	16.7–79.2	30.3–50	14–50	7–36.7	3.3–33.3
Colorectal (2)	4.3–18	6–6.7	17.4–47	13.3–18	35–78.3	76–80
Lung (1)	19	14	24	9	57	76
Gynecological (1)	20.8	22.7	32	18.9	47.2	58.4