Unique Aspects of Communication with Cancer Patients
Participation style in decision making represents how much patients want to be involved in the decision-making process related to their cancer. Studies of patient desire to participate in treatment decisions have yielded conflicting results, largely depending on how participation in decision making is defined. Participation can range from the patient actively engaging in the decision-making process, to the patient wanting the doctor to make the ultimate decision. The desire to participate in treatment decisions is associated with locus of control, which describes how an individual tends to attribute control. Patients with an internal locus of control seek information to control their own destinies, whereas those with an external locus of control tend to passively accept their lot.
Because research shows that a range of patient decision making exists, increasing participation for all patients may not be the most effective strategy. One study  categorized patients with early-stage breast cancer into the following groups:
- Delayers, who consider at least two options, but their deliberation is perfunctory and they immediately prefer one option.
- Deferrers, who accept their doctors' recommendations without a significant degree of reflection.
- Deliberators, who weigh the pros and cons of each treatment and do not make a choice until they have considered all the relevant information and have found an alternative with which they are satisfied.
Another study  identified four patterns to describe how patients' emotional styles affected treatment decision making. These styles were labeled passive, avoidant, panicked, and rational. Passive decision makers allowed directive physicians to make treatment choices for them. They responded more to the caring attitude of their provider and the need to have someone to believe in rather than to an opportunity for autonomous decision making. Women with breast cancer using an avoidant style of decision making refused to actively confront their diagnosis or participate in planning their cancer treatment. Panicked patients were so fearful when confronted with a diagnosis of cancer that they could not participate in decision making, whereas rational decision makers were able to control strong feelings of fear and engage fully in decision making. Results of another study found that whereas most well people preferred to play an active role in decision making, very sick people preferred the doctor to make decisions, suggesting that seriously ill people may prefer a degree of paternalism in their care because an active role in decision making may take more physical and mental energy than these patients can afford. Alternatively, there may be a limit to the amount of negative and pessimistic information people can absorb before their capacity for coping is seriously compromised.
Although the categorization of patients into various participation styles appears to offer some useful predictive power for defining communication patterns, the issues are complex. It has been suggested that to match the provision of information and support with the expressed needs of patients, patients should ideally be queried frequently about their needs.[14,29] Information and involvement preferences may also be responsive to factors such as changing disease status and the behavior of the physician during consultation. Individualizing treatment discussions to patients' preferred decision-making styles rather than encouraging decision-making autonomy is likely to maximize outcomes for patients with cancer.
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