by Nancy Meredith
Health advocates, physicians and the American Medical Association all encourage patients to build a trusting relationship with their mesothelioma doctors. This relationship empowers the patients to partner with their doctors when developing their treatment plan. However, according to a recent study, patients may be reluctant to disagree with their doctors even if the doctor's action does not match their own desires.
The study, published in the Archives of Internal Medicine, surveyed 1,340 adults that were asked to imagine they were diagnosed with heart disease, according to Reuters Health. They were then asked about how they wanted to be involved in their treatment decisions. While 90% of the respondents could envision asking their doctor questions and discussing their treatment-related preferences, less than 15% said they would bring up a disagreement if the doctor's recommendation differed from what they wanted. Still, close to 70% said they preferred making medical decisions together with their doctor, with each contributing equally to treatment calls.
A mesothelioma patient's survival and quality of life can depend on the treatment plan. The plan is built not only with the medical needs in mind, but also according to the patient's feelings regarding his level of care, aggressiveness of treatment, and at times, financial considerations. When the patient is comfortable with his physician and feels empowered to proactively participate in making the decisions for their care, the prognosis can improve.
The survey was led by Dominick L. Frosch, associate investigator in the Department of Health Services Research at the Palo Alto Medical Foundation Research Institute, who also conducted a smaller study with 48 patients. He found similar results.
He and his colleagues concluded that patients were inhibited from discussions for the following reasons:
- Even relatively affluent and well-educated patients feel compelled to conform to socially sanctioned roles and defer to physicians during clinical consultations;
- That physicians can be authoritarian; and
- That the fear of being categorized as "difficult" prevents patients from participating more fully in their own health care.
"We urgently need support of shared decision-making that is more than just rhetoric," Dr. Frosch said in an interview with the NY Times. "It may take a little longer to talk through decisions and disagreements; but if we empower patients to make informed choices, we will all do much better in the long run."
The findings may not come as a surprise to some. In an unrelated study, researchers set out to find out if patients discuss errors with their physicians. They found that even if a patient believes he experienced an error during treatment it is unlikely he will report it.
The Joint Commission, a not-for-profit organization that accredits and certifies health care organizations and programs in the United States, encourages patients to "make your care safer by being an active, involved and informed member of your health care team." The Commission sponsors a "Speak Up" campaign where patients are encouraged to speak up if they have questions or concerns. The information presented encourages patients to participate in all decisions about their treatment. In fact, the Joint Commission states, "You and your doctor should agree on exactly what will be done during each step of your care."
Mesothelioma is an asbestos-caused cancer diagnosed in close to 3,000 Americans each year. The cancer is aggressive and typically requires surgery, radiation and chemotherapy to treat the symptoms. There is no cure for the disease.
