Women with breast cancer want to be involved in decisions about their treatment but a new study shows that the extent to which they participate varies considerably between North America and Europe. Professor Lesley Degner from the University of Manitoba, Canada, has found that Canadian women preferred to take an active or collaborative role with their physicians in treatment decision making, whereas women in England and Sweden were more likely to want their doctors to make the decisions for them.
Speaking at the European Society for Medical Oncology Congress in Nice today (18 October 2002), Professor Degner described the surprising results that emerged in a series of studies of several hundred cancer patients, designed to improve communication between patients and health care providers. "Ironically, we found that women who wished to remain passive in the decision-making were most likely to get their own way because physicians would make their treatment decisions for them," she said. The patients least likely to achieve their preferred roles in decision-making were those who wanted to make the decisions themselves. Professor Degner studied groups of women with breast cancer and men with prostate cancer.
The women in Canada tend to regard their illness as more positive, as a challenge or having some value, whereas women in Europe have a more negative attitude. As a result, the Canadians tend to fare better emotionally and socially, experiencing less depression than European women. Data from men in Canada with prostate cancer also shows that they want to take an active role in treatment choices and, like the women, had lower levels of anxiety when they assumed more active roles in decision-making.
The most important information that women and men with cancer want, whether they live in North America or Europe, is, 'What are my chances of a cure?' and 'How far has my disease spread?'
Professor Degner recognises the profound gap in communication between doctors and patients. Doctors tend to be guided by what they think the patient wants to know. "The patient is often overwhelmed and stressed when cancer is diagnosed and may not be able to articulate his or her questions," she said. Doctors should, therefore, find a way of soliciting the patient's concerns. "Dialogue, rather than questions and answers, between doctors and patients is very important to give the patient the opportunity to become involved in decisions and choices," she said. If doctors are taking their cues from their patients, the patients should raise their concerns with their doctor.
"If you are worried about your prognosis or treatment, talk about it," she said.
Although Professor Degner cautions against simply exporting recommendations from North America to Europe, the next phase of the study involving the Canadian women will try and determine whether there is a link between a positive outlook and long-term survival.