Exploring decision-making preferences around treatment in patients with advanced and recurrent uterine cancer

Advanced and recurrent uterine cancer has a poor prognosis despite emerging treatment options, complicating the decision-making process. This study aimed to assess patient decision preferences and identify important factors in treatment choices to investigate whether these preferences vary by clinical and demographic characteristics, including race.

This was a mixed-methods cross-sectional study, with the administration of validated surveys on quality of life and shared decision-making. Participants with advanced or recurrent uterine cancer at a single urban academic medical center completed an exploratory survey tool and a semi-structured interview. Descriptive statistical analysis, logistic regression, and thematic qualitative analysis were performed.

A total of 110 patients were included, with a mean age of 65.7 years. Fifty-three (48.2%) patients identified as White, and 46 (41.8%) identified as Black. Sixty patients (60/110, 54%) preferred "shared decision-making," with no association between this preference and demographics, co-morbidities, or disease characteristics (all P > .1). Participants who were currently employed preferred shared decision-making compared with those who were not employed (odds ratio 0.32, 0.12-0.88, p < .05). While participants reported a range of factors influencing their treatment decisions, the most frequently identified were treatment efficacy (78%), physician recommendation (73%), and side effects (54%). Top decision preferences varied by race: White participants ranked treatment efficacy or physician recommendation more often than Black patients (treatment efficacy, White 86.8% vs Black 70.8%, p < .05; physician recommendation, White 84.9% vs Black 64.6%, p = .02), while more Black participants than White participants reported "length of treatment visits" as the most important factor (Black 18.8% vs White 3.8%, p = .02).

The majority of participants with advanced and recurrent uterine cancer preferred shared decision-making. Various factors, such as treatment efficacy, physician recommendation, and side effects, among others, are important in decision-making processes. Individual patient characteristics such as race, employment status, and others should be considered in a patient-centered approach to care.