A matter of trust – patient's views on decision‐making in colorectal cancer

OBJECTIVES: To determine which aspects of the treatment decision process, therapy and outcomes are most important to patients with colorectal cancer (CRC). DESIGN: Cross-sectional survey. PARTICIPANTS: A total of 102 men and 73 women who had completed primary treatment for CRC in two teaching hospitals in Central Sydney, Australia. MAIN OUTCOMES MEASURES: Patient's rating of the importance of the decision-making aspects and outcomes of treatment for CRC. RESULTS: Trust in their surgeon and confidence of specialty training are of paramount importance to CRC patients. Patients also have a strong desire to get on with treatment quickly and rate the risk of disease recurrence and quality of life as being very important in their treatment decisions. Gender, age and whether the patient had undergone adjuvant radiotherapy were all significant predictors of preferred mode of treatment decision-making. Fifty-eight per cent of women preferred a shared decision-making role compared with 36% of men, whilst older patients and those who had undergone adjuvant radiotherapy were significantly more likely to prefer that their surgeon decide upon treatment when compared with younger patients and respondents who have not had radiotherapy. CONCLUSIONS: Regardless of whether a patient prefers an active or more passive role in decision-making, having a surgeon explain treatment options in a clear, unhurried and open manner is vital to how patients feel about their treatment. Whilst acknowledging that individual patients will have different needs for information and preferences for treatment, there are several factors amongst many in the process of decision-making which are considered very important by patients with CRC. A surgeon who adopts a consultation style that is open and informative, that offers patients the chance to participate in the process of decision-making and clearly explain treatment options and outcomes will engender trust with their patient.