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Resilient patients are more active in treatment decisions


 

AT THE WORLD CONGRESS OF PSYCHO-ONCOLOGY

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WASHINGTON – Patients with cancer who have good coping skills – the ability to roll with the punches – are more likely to want an active role in treatment decisions, investigators say.

Among adults who were currently undergoing chemotherapy for a variety of cancers, those with a more active coping style, greater psychological resilience, and greater “openness to experience” were more likely to be active participants in the clinical decision-making process, reported Alexis Colley, a third-year medical student at the University of California Berkeley and UC San Francisco joint medical program.

Demographic factors also appear to play a role in patient participation.

“There has been quite a bit of research which shows that certain factors like younger age, higher education, and higher income tend to be associated with people who want to participate actively,” Ms. Colley said in an interview at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To explore the role of psychological factors in patients’ decision-making choices, the investigators enrolled 868 adults, mean age 57, with breast, lung, gastrointestinal, or gynecologic cancers, who had received chemotherapy within the last 4 weeks and were scheduled for at least two additional cycles.

The patients were asked to report their decision-making roles and psychological factors on several validated instruments. These included evaluations of:

• The patient’s self-reported and actual decision-making roles with the Control Preferences Scale.

• Coping ability with the Brief COPE Scale.

• Resilience with the Connor–Davidson Resilience Scale.

• Personality with the Neuroticism-Extraversion-Openness Five-Factor Inventory.

In multivariate analysis, factors significantly associated with more active decision-making included the demographic factors of younger age (P less than .001) and more years of education (P = .011), and the psychological variables of active coping style (P less than .001), greater use of emotional support in coping (P = .002), openness to experience (P = .014), and higher levels of neuroticism (P less than .030).

In contrast, people with more comorbidities were less prone to be active decision makers (P = .028), as were those who experienced more evening fatigue (P less than .001).

“This relationship between decision-making role and number of comorbid conditions may indicate that serious illness affects patient involvement in the decision-making process because of a need for increased support and guidance as illness progresses,” the authors write in a poster presentation.

There was a high degree of concordance (89.5%) between patients’ preferred and actual decision-making roles, the authors found. They noted that “patients with more active roles and preferred roles that match their actual role have better health outcomes and are more satisfied.”

The study points to the need for further study of the role that psychological factors can play in patient decision making, Ms. Colley said.

“The question arises as to how one’s coping style might be a strong influence on the way they want to participate in decision making, and perhaps as clinicians we can support or teach various coping styles that might help people achieve the role they want and/or achieve a more active role which might then lead to better outcomes, “ she said.

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