The role of families in decisions regarding cancer treatments

Cancer. 2015 Apr 1;121(7):1079-87. doi: 10.1002/cncr.29064. Epub 2015 Feb 23.

Abstract

Background: Shared decision-making is an important component of patient-centered care and is associated with improved outcomes. To the authors' knowledge, little is known concerning the extent and predictors of the involvement of a patient's family in decisions regarding cancer treatments.

Methods: The Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium is a large, multiregional, prospective cohort study of the cancer care and outcomes of patients with lung and colorectal cancer. Participants reported the roles of their families in decision-making regarding treatment. Multinomial logistic regression was used to assess patient factors associated with family roles in decisions.

Results: Among 5284 patients, 80 (1.5%) reported family-controlled decisions, with the highest adjusted rates (12.8%) noted among non-English-speaking Asians. Among the 5204 remaining patients, 49.4% reported equally sharing decisions with family, 22.1% reported some family input, and 28.5% reported little family input. In adjusted analyses, patients who were married, female, older, and insured more often reported equally shared decisions with family (all P <.001). Adjusted family involvement varied by race/ethnicity and language, with Chinese-speaking Asian (59.8%) and Spanish-speaking Hispanic (54.8%) patients equally sharing decisions with family more often than white individuals (47.6%). Veterans Affairs patients were least likely to report sharing decisions with family, even after adjustment for marital status and social support (P <.001).

Conclusions: The majority of patients with newly diagnosed lung or colorectal cancer involve family members in treatment decisions. Non-English-speaking Asians and Hispanics rely significantly on family. Further studies are needed to determine the impact of family involvement in treatment decisions on outcomes; until then, physicians should consider eliciting patients' preferences for family involvement.

Keywords: cohort study; colorectal neoplasms; decision-making; lung neoplasms; professional-family relations; shared.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colorectal Neoplasms / psychology
  • Colorectal Neoplasms / therapy*
  • Decision Making*
  • Family*
  • Female
  • Follow-Up Studies
  • Hispanic Americans
  • Humans
  • Lung Neoplasms / psychology
  • Lung Neoplasms / therapy*
  • Male
  • Middle Aged
  • Patient Preference / psychology*
  • Patient Satisfaction*
  • Prognosis
  • Prospective Studies
  • Young Adult