Previous research presents strong evidence favoring shared decision-making after a medical diagnosis. One major improvement has been designing treatment plans that include a good deal of the patient’s goals and thus improved physician and patient satisfaction. Communication between patient and physician is improving and resulting in more positive outcomes.
Background
Diffuse large B-cell lymphoma (DLBCL) has rather dissimilar elements. This makes it difficult to decide on treatment plans for DLBCL patients who have relapsed and are ineligible for a transplant. By engaging in shared decisions which include the patient or caregiver’s preferences, the outcome will result in improved patient participation as well as satisfaction.
According to a recent article published in the HemotologyAdvisor, data concerning shared decisions are sparse. Therefore, a group of researchers investigated decision-making by oncologists, physicians, and caregivers among patients with refractory and relapsed DLBLC. These patients were not eligible for transplants.
About the Study
Enrollment included thirty patients of which fourteen with DLBCL had received at least two lines of treatment within the previous five years. Eight caregivers and eight oncologists were included. Half of the patients were over fifty years of age as were 87 percent of caregivers. The majority of caregivers in the study were white.
One-hour interviews were conducted suggesting that treatment failure or shock from their diagnosis kept patients and their caregivers from involvement in treatment discussions.
Patients were under the impression that the treatment plans they were given followed standard practice. The end result was that seventy-one percent of patients and thirty-eight percent of caregivers felt their participation in decisions was low.
The Clinicians Viewpoint
Clinicians agree that in cases where a standard of care has been established, barriers may reasonably exist in patient decision involvement. But forty-three percent of patients believed that after receiving a second line of treatment they had accumulated sufficient experience to become involved in their treatment decisions.
Seventy-one percent of patients were given educational materials by their oncologists. However, a few patients indicated they had other concerns that were not covered such as mental health or fertility.
Patients credited their caregivers for enhancing their understanding of discussions relating to their treatment. It is noteworthy that all physicians encouraged caregiver participation in treatment-related discussions.
Seventy-one percent of patients interviewed were satisfied with their experience, but twenty-one percent would have preferred a more personalized approach.
In conclusion, the study suggests that although second and third-line relapse and refractory options are limited, patient goals may still be included in treatment planning.
