Cancer Patient's Medical Decision-Making Preference Among Doctor, Family And Self

Background: With the reform of medical model, patient's opinion is considered more important than before. Besides, family also plays an important role in medical decision-making in the context of family-centered culture in China. To explore cancer patient's decision-making preference among doctor, family and self is rather necessary. It will provide some evidence for medical workers to make a proper medical decision.Objective: (1) To describe the cancer patient's medical decision-making preference among doctor, family and self both in ideal and actual situation; (2) To explore the impacts of sociodemographic factors, disease status and level of health, and psychological status on cancer patient's medical decision-making preference.Method: Purposive sampling was applied to recruit 120 cases of cancer inpatients in a cancer hospital in Beijing in September-December 2008. Participants were surveyed by a questionnaire and a semi-structure interview to understand their medical decision-making preference among doctor, family and self both in the ideal and actual situation.The medical decision referred to the decision making on lifestyle, seeking doctor, routine tests, general treatment project, operation, chemotherapy and radiotherapy in this study. The impacts of sociodemographic factors, disease status and level of health, and psychological status on cancer patient's medical decision-making preference were also studied.Results: (1) The constituent ratios of cancer patient's medical decision-making preference referred to lifestyle among doctor, family and self were respectively 20%, 20% and 40% in actual situation, and were 32 %, 20% and 33% in ideal situation. The constituent ratio of cancer patient's medical decision-making preference referred to seeking doctor among doctor, family and self were respectively 0, 50% and 20% in actual situation, and were 0, 50% and 20% in ideal situation. The constituent ratios of doctor in cancer patient's medical decision-making preference referred to routine tests were both 100% in actual and ideal situation. The constituent ratios of doctor in cancer patient's medical decision-making preference referred to general treatment project were both 90% in actual and ideal situation. The constituent ratios of doctor in cancer patient's medical decision-making preference referred to operation were both 100% in actual and ideal situation. The constituent ratios of doctor in cancer patient's medical decision-making preference referred to chemotherapy were both 90% in actual and ideal situation. The constituent ratios of doctor in cancer patient's medical decision-making preference referred to radiotherapy were both 100% in actual and ideal situation.(2)There was no difference in cancer patient's medical decision-making preference in ideal and actual situation (P>0.05) by nonparametric test, but 35 (29.17%) patients considered that the process of decision-making were not very satisfied by interview. (3) Gender, number of children, marital status, occupation, the method of paying medical expenditure, relationship with the main participate family member and results of blood routine impacted cancer patient's medical decision-making preference among doctor, family and self by nonparametric tests (P<0.05); Duration, EQ-5D score and Karnofsky score were also related to cancer patient's medical decision-making preference by the Spearman correlation analysis.Conclusion: (1) Cancer patient's medical decision-making preference differed in different kinds of decision. They preferred to themselves in decision referred to lifestyle, preferred to family in decision referred to seeking doctor, while preferred to doctor in decision referred to tests and treatments. (2) On the whole, cancer patients were satisfied with the process of decision-making, but some patients wanted more communication with doctor or playing a more important role in decision-making. (3)Patients with different sociodemographic features, disease status and level of health, and psychological status differed in medical decision-making preference.