De patiënt kiest: werkbaar en effectief

Objective

To investigate whether patients want to choose between a lower and higher radiation dose, what the patients’ and doctor’s preferences are, whether the patient’s choice is well-reasoned, and to assess the effects of offering a choice.

Design

Prospective, randomised study.

Method

Patients with early prostate cancer were included and assigned to an intervention group using a decision aid (n = 150) or a control group (n = 144). The intervention group was offered a choice between a higher or lower radiation dose (74 Gy versus 70 Gy) and received information on the chance of cure and side-effects associated with both doses. The control group was not offered a choice. Patient well-being, involvement in the treatment choice, and knowledge of the treatment was assessed with questionnaires at 4 time points between the start of the study and 6 months after treatment.

Results

Of the 150 patients in the intervention group, 119 (79%) made a choice themselves. Based on the investigated characteristics, it was not possible to predict who would wish to make their own choice. Of the 119 patients who wished to choose, 75% preferred the lower dose. Their choices were well-reasoned. The physicians believed that 51% would prefer the lower dose. They considered the lower dose preferable in 20% of the cases.

Conclusion

Many patients wanted to choose for themselves. Patients were more likely to choose to maintain their quality of life, while physicians were more likely to focus on a higher chance of cure. Physicians overestimate patients’ desire for more intensive treatment. The decision aid improved the patient’s knowledge and involvement without negatively affecting their well-being.