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Supporting Treatment Decision Making in Advanced Cancer


For those diagnosed with cancer, there are many who strive to acquire comprehensive information about their disease, treatments and prognosis. These patients typically desire to play a significant role in information gathering and decision-making about their treatments. Unfortunately, based on lack of appropriate information, poor sources of information and knowledge limitations in understanding the information, many are ill-equipped to make these decisions (Anderson et al, 2008; Gattellari et al, 1999). Anxiety, being overwhelmed by the medical system and health care team and excessive information can contribute to inability to process information and make informed decisions.

Patient preference for learning and meeting informational needs are varied. One approach to fostering patients’ understanding and involvement in medical decision making is a decision aid (DA).  Leighl and colleagues (2004) pilot-tested a DA for metastatic colorectal cancer patients who were contemplating first-line chemotherapy.This tool demonstrated a viable movement toward improved patient knowledge minus increasing anxiety. The DA was revised based on patient input and was used in a randomized study of patients diagnosed with advanced colorectal cancer (CRC) who were seeing a medical oncologist to discuss first-line systemic treatment. (Leighl et al, 2011).

This study randomized patients to standard consultation with an oncologist or consultation where a DA was reviewed and the patient given a copy. The primary objective of the study was to evaluate the effect of the DA on patient understanding of prognosis, treatment options and satisfaction with decision making.There were 207 randomly assigned patients, 100 to the standard arm and 107 to receive the DA.


  • Patients who received the DA had a increased understanding of prognosis, treatment options and benefits with a higher overall understanding (P<.001)
  • In both study arms 68% of patients preferred to have all possible information
  • Anxiety was low to moderate at all time points, decreasing over time and similar in both groups
  • Decision satisfaction and conflict scores were similar in both arms
  • Most patients selected chemotherapy: 77% in the DA arm and 71% in the standard arm

ManageCRC Commentary

Patients with CRC and their significant others presenting for initial medical oncology consultation typically express some level of anxiety about their diagnosis and anticipated experiences as they move through the cancer trajectory.The results of this study identified the anxiety level as low to moderate across all study time points which were at initial consultation, immediately following consultation, post-treatment and 4 weeks post-treatment decision; anxiety levels decreasedover time. In practice, the transformation of anxiety to confidence/acceptance of the cancer journey frequently mimics this finding. The authors’ findings are relevant and complement the nursing process for educating and informing patients and their support systems. With the changing treatment landscape in oncology, the applicability of the DA to other aspects of oncology care would provide an interesting exploration for oncology nurses. In particular, this tool may be designed to underscore the value and rationale for oral therapy adherence. The DA has great potential to be developed and expanded to augment the efforts of the oncology health care team; however, further research is required.


  1. Anderson, A.E. & Klemm, P. (2008), The internet: Friend or foe when providing patient education? Clinical Journal of Oncology Nursing, 12 (1), 55-63. doi: 10.1188/08.CJON.55-63 Link to abstract: http://www.ncbi.nlm.nih.gov/pubmed/18258575
  2. Gattellari, M., Butow, P.N., Tattersall, M.H.N., Dunn, S.M.  & MacLeod, C.A. (1999) Misunderstanding in cancer patients: Why shoot the messenger?  Annals of Oncology, 10 (1), 39-46. Free full text available: http://annonc.oxfordjournals.org/content/10/1/39.long
  3. Leighl, N.B., Butow, P.N. & Tattersall, M.H.N. (2004) Treatment decision aids in advanced cancer: When the goal is not cure and the answer is not clear. Journal of Clinical Oncology, 22 (9), 1759-1762. doi: 10.1200/JCO.2004.02.166 Free full text available: http://jco.ascopubs.org/content/22/9/1759.long
  4. Leighl, N.B., Shepherd, H.L., Butow, P.N., Clarke, S.J., McJannett, M., Beale, P.J.,…Tattersall, M.H.N. (2011). Supporting treatment decision making in advanced cancer: A randomized trial of a decision aid for patients with advanced colorectal cancer considering chemotherapy. Journal of Clinical Oncology, 29 (15), 2077-2084. doi: 10.1200/JCO.2010.32.0754 Link to abstract: http://www.ncbi.nlm.nih.gov/pubmed?term=Supporting%20treatment%20decision%20making%20in%20advanced%20cancer%3A%20A%20randomized%20trial%20of%20a%20decision%20aid%20for%20patients%20with%20advanced%20colorectal%20cancer%20considering%20chemotherapy 

Article Created On : 8/4/2011 10:04:24 AM             Article Updated On : 8/4/2011 10:04:24 AM