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Patient and Physician Preferences for Surgical and Adjuvant Treatment Options for Rectal Cancer
James D. Harrison, BSc(Hons), MPH;
Michael J. Solomon, MBBCh(Hons), MSc, FRACS;
Jane M. Young, MBBS, MPH, PhD, FAFPHM;
Alan Meagher, MBBS, FRACS;
Phyllis Butow, BA(Hons), DipEd, MClinPsych, MPH, PhD;
Glenn Salkeld, BBus, GDipHealthEcon, MPH, PhD;
George Hruby, MBBCh, FRANZCR;
Stephen Clarke, MBBS, PhD, FRACP, FAChPM
Arch Surg. 2008;143(4):389-394.
Hypothesis Patients and their clinicians hold varying preferences for surgical and adjuvant treatment therapies for rectal cancer.
Design Preferences were determined using the Prospective Measure of Preference.
Setting Royal Prince Alfred and St Vincent's hospitals in Sydney, Australia.
Participants Patients with colorectal cancer were interviewed during their postoperative hospital stay, and physicians were asked to complete a mailed survey.
Main Outcome Measures The Prospective Measure of Preference method produces 2 outcome measures of preference: willingness to trade and prospective measure of preference time trade-off.
Results Patients' strongest preference was to avoid a stoma: more than 60% would give up a mean of 34% of their life expectancy to avoid this surgical option. This was followed by treatment options involving chemoradiotherapy, where more than 50% would give up a mean of almost 25% of their life to avoid treatment. Surgeons held stronger preferences against all adjuvant options compared with oncologists (P  .01).
Conclusions Patients had strong preferences against all treatment options, and these preferences frequently differed from those of physicians. These results highlight the importance of determining patients' own preferences in the clinical encounter. Furthermore, the diversity of preferences of clinical subspecialists emphasizes the need for multidisciplinary treatment planning to ensure a balanced approach to treatment decision making for patients with rectal cancer.
Author Affiliations: Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service and University of Sydney (Mr Harrison and Drs Solomon, Young, Butow, and Salkeld); Department of Colorectal Surgery, St Vincent's Hospital (Dr Meagher); Departments of Radiation Oncology (Dr Hruby) and Medical Oncology (Dr Clarke), Sydney Cancer Centre; and Department of Colorectal Research, Royal Prince Alfred Hospital (Dr Solomon), Sydney, Australia.
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