Shared Decision Making, Perceived Control Improves Patient Satisfaction During Radiation Therapy

Neha Vapiwala, MD

Cancer patients felt more satisfied with their radiation treatment when they remained active in treatment decisions, according to a study conducted by researchers from the Perelman School of Medicine at the University of Pennsylvania.

The study, which was published in Cancer, analyzed 305 patients, ranging in age from 18 to 87 years old, who were undergoing radiation treatment.

“Most importantly, our findings emphasize the value of patient—physician relationships and communication specifically in radiation oncology, and their impact on patient experience in a way that hasn’t been shown before,” Neha Vapiwala, MD, an associate professor in the department of Radiation Oncology at Penn Medicine, said in a press release. “No matter where cancer patients are in the treatment process, there is always an opportunity to improve patient satisfaction—something hospitals and providers have consciously and increasingly been making a priority.”

The study found that patients who experienced shared decision making (SDM) or perceived some control over their treatments were more satisfied with their care than those who did not experience SDM or perception of control—a difference of almost 17% and 26%, respectively.

The researchers also found that patients who desired control over treatments but did not perceive this control experienced an increase of anxiety, depression, and fatigue.

Among the participants in the study, 31% of patients experienced SDM, 32% perceived control in decisions, and 76% reported feeling very satisfied with their radiation treatment course overall.

According to the study, there was a significant association noted between patient satisfaction with his/her radiation treatments and patient-perceived experience of SDM (84.4% vs 71.4%) or perceived control over one’s treatment (89.7% vs 69.2%).

Patients who specifically desired control over their treatment decisions, but did not perceive this control, experienced significantly more anxiety (44% vs 20%), depression (44% vs 15%), and fatigue (68% vs 39.2%), compared with patients who did not perceive a sense of control in their treatment decisions.

Radiation oncology is often seen as a treatment avenue that is ultimately left to the physician to dictate. However, there are tailored options, decisions, and discussions that can apply to individual patients, even if they all have similar diagnoses.

Different radiation regimens, dosages, risks and benefits, as well as pain management issues, should be part of the ongoing conversation.

“As providers, it doesn’t matter what treatment you are offering, or how complicated it is, or how busy you may be,” said Vapiwala. “It’s worth taking even a few minutes to talk to patients about seemingly minor decisions in which they can provide some input. It’s not only critical in today’s healthcare setting where both information and misinformation are rampant, but will very likely lead to the patient feeling positively about the encounter.”