Patient-Reported Roles in Decision-Making Among Asian Patients With Advanced Cancer: A Multicountry Study

Area of Science:

• Oncology
• Health Services Research
• Patient-Centered Care

Background:

• Patient involvement in decision-making varies significantly across different cultural contexts.
• Understanding patient preferences for decision-making roles is crucial for delivering patient-centered care in advanced cancer.
• Previous research has explored decision-making roles, but cross-cultural comparisons in Asian populations are limited.

Purpose of the Study:

• To investigate perceived decision-making roles among advanced cancer patients in five Asian countries.
• To identify patient characteristics associated with different decision-making roles.
• To examine the association between perceived decision-making roles and quality of life and care.

Main Methods:

• A survey was conducted with 1585 patients diagnosed with stage IV solid cancer across five Asian countries.
• Multinomial logistic regression analyses were used to explore associations between patient characteristics and decision-making roles.
• Multivariate regression models assessed the impact of decision-making roles on quality of life and quality of care.

Main Results:

• The most frequently reported perceived role was no patient involvement; however, 73% of patients reported roles aligning with their preferences.
• Higher patient involvement was associated with being male, nonminority status, higher education, awareness of advanced cancer diagnosis, and longer duration of diagnosis knowledge.
• Joint decision-making correlated with enhanced social and spiritual well-being and improved physician communication and care coordination. Conversely, making decisions alone was linked to lower emotional, social, and spiritual well-being.

Conclusions:

• A significant proportion of advanced cancer patients do not desire involvement in decision-making, aligning with their preferences.
• Despite this, joint decision-making involving physicians and family demonstrated a positive association with improved quality of life and care.
• Physicians should actively discuss the benefits of shared decision-making, encouraging patient participation while ensuring patients feel supported and not overwhelmed.