Assessing the quality of initial consultations regarding adjuvant colon cancer therapy.

BACKGROUND: Adjuvant chemotherapy prevents colon cancer recurrence in a subset of treated patients; however, decisions about whether to receive chemotherapy are complex. Adequate information exchange (IE) and informed decision making (IDM) between patient and physician are essential, particularly in the elderly. PATIENTS AND METHODS: A total of 35 patients with stage II and III colon cancer were asked on a questionnaire if they discussed specific colon cancer-related information and elements of IDM with their doctors during their initial adjuvant chemotherapy consultations. RESULTS: On average, patients reported discussing 14.6 (SD +/- 6.6) of 28 information items with their doctors. Basic items about cancer stage, prognosis, and treatment were discussed more commonly (mean, 9 of 12) than information about short-term (mean, 3.5 of 8) and long-term (mean, 2.3 of 8) effects of therapy. Patients aged >or= 70 years reported discussing fewer information items with their physicians than patients aged < 70 years (mean, 11 items vs. 16.2 items; P = .06). Patients reported discussing an average of 5.1 (SD +/- 1.3) of 7 IDM elements with their physicians. Thirty-four percent of the patients did not recall being asked their preference about chemotherapy, and 23% did not recall their doctor checking to ensure that they understood the discussion. Concordance with patient report and coded transcripts was good among 5 available patient-transcript pairs. CONCLUSION: By patient report, IE and IDM quality appeared to be very good in initial adjuvant therapy consultations, though attention to patient preference could be an area for improvement. Differences in decision quality between younger and older patients are an important area for future study.

Duke Scholars

Author Michael Patrick Pignone Medicine, General Internal Medicine