Sjaak Molenaar

Predictors of patients' choices for breast-conserving therapy or mastectomy: a prospective study.

A study was undertaken to describe the treatment preferences and choices of patients with breast cancer, and to identify predictors of undergoing breast-conserving therapy (BCT) or mastectomy (MT). Consecutive patients with stage I/II breast cancer were eligible. Information about predictor variables, including socio-demographics, quality of life, patients’ concerns, decision style, decisional conflict and perceived preference of the surgeon was collected at baseline, before decision making and surgery. Patients received standard information (n=88) or a decision aid (n=92) as a supplement to support decision making. A total of 180 patients participated in the study. In all, 72% decided to have BCT (n=123); 28% chose MT (n=49). Multivariate analysis showed that what patients perceived to be their surgeons’ preference and the patients’ concerns regarding breast loss and local tumour recurrence were the strongest predictors of treatment preference. Treatment preferences in itself were highly predictive of the treatment decision. The decision aid did not influence treatment choice. The results of this study demonstrate that patients’ concerns and their perceptions of the treatment preferences of the physicians are important factors in patients’ decision making. Adequate information and communication are essential to base treatment decisions on realistic concerns, and the treatment preferences of patients.

Patient participation and decision control: are patient autonomy and well-being associated?

than the more global concept of maximal health. For example, suppose Study A has measured a utility of 0.7 for angina on a scale defined over death (= 0) and &dquo;no angina&dquo; (= 1), and that in Study B the utility of angina has been measured using scale anchors of death (= 0) and maximum health (= 1). The comparability of the QALYs estimated from the two measurements is a function of comorbidity in persons with angina. To remove my angina is not to return me to maximum health if I also suffer from

8 Communicatie en teamwork

Medische zorg wordt jaarlijks complexer. Hoe gecompliceerder de zorg, hoe meer overdrachtmomenten en zorgverleners, hoe groter de kans op miscommunicatie met als gevolg ongewenste gebeurtenissen met schadelijke gevolgen. Zorgprocessen staan of vallen met een goed verlopende communicatie tussen zorgverleners onderling en tussen zorgverleners en patienten. Communicatie, samenwerking en effectiviteit zijn begrippen die nauw met elkaar verbonden zijn. Wanneer de communicatie en de samenwerking niet goed verlopen, dan heeft dit direct invloed op de effectiviteit, de doelmatigheid en de veiligheid van de patientenzorg.