Understanding patients’ values and preferences regarding early stage lung cancer treatment decision making

Donald Sullivan, Karen Eden, Nathan Dieckmann, Sara E. Golden, Kelly C. Vranas, Shannon M. Nugent, Christopher G. Slatore

Research output: Contribution to journalArticle

Abstract

Introduction: With advances in treatments among patients with lung cancer, it is increasingly important to understand patients’ values and preferences to facilitate shared decision making. Methods: Prospective, multicenter study of patients with treated stage I lung cancer. At the time of study participation, participants were 4–6 months posttreatment. Value clarification and discrete choice methods were used to elicit participants’ values and treatment preferences regarding stereotactic body radiation therapy (SBRT) and surgical resection using only treatment attributes. Results: Among 114 participants, mean age was 70 years (Standard Deviation = 7.9), 65% were male, 68 (60%) received SBRT and 46 (40%) received surgery. More participants valued independence and quality of life (QOL) as “most important” compared to survival or cancer recurrence. Most participants (83%) were willing to accept lung cancer treatment with a 2% chance of periprocedural death for only one additional year of life. Participants also valued independence more than additional years of life as most (86%) were unwilling to accept either permanent placement in a nursing home or being limited to a bed/chair for four additional years of life. Surprisingly, treatment discordance was common as 49% of participants preferred the alternative lung cancer treatment than what they received. Conclusions: Among participants with early stage lung cancer, maintaining independence and QOL were more highly valued than survival or cancer recurrence. Participants were willing to accept high periprocedural mortality, but not severe deficits affecting QOL when considering treatment. Treatment discordance was common among participants who received SBRT or surgery. Understanding patients’ values and preferences regarding treatment decisions is essential to foster shared decision making and ensure treatment plans are consistent with patients’ goals. Clinicians need more resources to engage in high quality communication during lung cancer treatment discussions.

Original languageEnglish (US)
Pages (from-to)47-57
Number of pages11
JournalLung Cancer
Volume131
DOIs
StatePublished - May 1 2019

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Patient Preference
Lung Neoplasms
Decision Making
Therapeutics
Radiotherapy
Quality of Life
Recurrence
Time and Motion Studies
Survival
Nursing Homes
Multicenter Studies
Neoplasms
Communication
Prospective Studies

Keywords

  • Decision making
  • Lung cancer
  • Patient values and preferences
  • Quality of life
  • Radiation therapy
  • Shared decision making
  • Surgical resection
  • Treatment concordance

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Understanding patients’ values and preferences regarding early stage lung cancer treatment decision making. / Sullivan, Donald; Eden, Karen; Dieckmann, Nathan; Golden, Sara E.; Vranas, Kelly C.; Nugent, Shannon M.; Slatore, Christopher G.

In: Lung Cancer, Vol. 131, 01.05.2019, p. 47-57.

Research output: Contribution to journalArticle

Sullivan, Donald ; Eden, Karen ; Dieckmann, Nathan ; Golden, Sara E. ; Vranas, Kelly C. ; Nugent, Shannon M. ; Slatore, Christopher G. / Understanding patients’ values and preferences regarding early stage lung cancer treatment decision making. In: Lung Cancer. 2019 ; Vol. 131. pp. 47-57.
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abstract = "Introduction: With advances in treatments among patients with lung cancer, it is increasingly important to understand patients’ values and preferences to facilitate shared decision making. Methods: Prospective, multicenter study of patients with treated stage I lung cancer. At the time of study participation, participants were 4–6 months posttreatment. Value clarification and discrete choice methods were used to elicit participants’ values and treatment preferences regarding stereotactic body radiation therapy (SBRT) and surgical resection using only treatment attributes. Results: Among 114 participants, mean age was 70 years (Standard Deviation = 7.9), 65{\%} were male, 68 (60{\%}) received SBRT and 46 (40{\%}) received surgery. More participants valued independence and quality of life (QOL) as “most important” compared to survival or cancer recurrence. Most participants (83{\%}) were willing to accept lung cancer treatment with a 2{\%} chance of periprocedural death for only one additional year of life. Participants also valued independence more than additional years of life as most (86{\%}) were unwilling to accept either permanent placement in a nursing home or being limited to a bed/chair for four additional years of life. Surprisingly, treatment discordance was common as 49{\%} of participants preferred the alternative lung cancer treatment than what they received. Conclusions: Among participants with early stage lung cancer, maintaining independence and QOL were more highly valued than survival or cancer recurrence. Participants were willing to accept high periprocedural mortality, but not severe deficits affecting QOL when considering treatment. Treatment discordance was common among participants who received SBRT or surgery. Understanding patients’ values and preferences regarding treatment decisions is essential to foster shared decision making and ensure treatment plans are consistent with patients’ goals. Clinicians need more resources to engage in high quality communication during lung cancer treatment discussions.",
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