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14. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

7. - 9. Oktober 2015, Berlin

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Patient-preferences in multidisciplinary decision making in geriatric cancer patients

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  • Andre L. Mihaljevic - Universitätsklinik Heidelberg, Chirurgische Klinik, Heidelberg, Deutschland
  • Inga Rossion - Universitätsklinik Heidelberg, Heidelberg, Deutschland
  • Markus Diener - Universitätsklinik Heidelberg, Heidelberg, Deutschland
  • M.W. Büchler - Universitätsklinik Heidelberg, Chirurgische Klinik, Heidelberg, Deutschland

14. Deutscher Kongress für Versorgungsforschung. Berlin, 07.-09.10.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocFV21

doi: 10.3205/15dkvf015, urn:nbn:de:0183-15dkvf0151

Published: September 22, 2015

© 2015 Mihaljevic et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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Background: Although treatment decisions concerning cancer patients are frequently made by multidisciplinary tumour boards and treatment teams, international studies have indicated that preferences of essential stakeholders including patients, caregivers and primary care physicians are inadequately considered in this process. Geriatric patients in particular are believed to be at high risk to suffer from paternalistic decision-making as treatments might be based on preconceptions and chronologic age rather than valid assessment, preferences and capabilities.

Question: We aimed to analyse treatment decision of multidisciplinary tumour boards and out-patient clinics in a tertiary referral centre in patients with colorectal (CRC) and pancreatic cancer (PC).

Methods: We analysed all multidisciplinary tumour board sessions for colorectal and pancreatic cancer patients as well as treatment decisions made in out-patient clinics in a tertiary referral centre with a standardized metric system (MODe, Metric for the observation of Decision making) within a 3 months period.

Results: Over a 3 months period 54 cases of colorectal cancer patients and 48 pancreatic cancer patients were evaluated. While both patient groups scored high in the history (CRC mean 4.6 out of 5; PC 4.8 out of 5), radiology (CRC mean 4.4 out of 5; PC 4.8 out of 5) and pathology subdomains (CRC median 3.6 out of 5, PC 4.2 out of 5), evaluation of psychosocial factors (CRC mean 1.4 out of 5; PC 1.8 out of 5), co-morbidities (CRC mean 2.2 out of 5; PC 2.4 out of 5) and patient´s views (CRC mean 1.2 out of 5; PC 1.6 out of 5) was dismal. Furthermore, only a minority of geriatric patients over 70 years of age (CRC 12%; PC 16%) received treatment decisions based on an in depth geriatric assessment. Essential stakeholders like primary care physicians, caregivers and nurses were not involved in decision making.

Discussion: Despite decision making by multidisciplinary tumour boards, consideration of patient views, essential psychosocial factors, thorough assessment of geriatric cancer patients and involvement of essential stakeholders is currently insufficient.