Abstract
INTRODUCTION: Exploring informational and decisional control preferences as well as examining concordance and patient-caregiver-physician factors associated with preferences in older adults with cancer and their caregivers may help to better understand the role of caregivers in supporting decision-making. MATERIALS AND METHODS: We utilized data from a national geriatric assessment (GA) cluster-randomized trial (NCT02054741; PI: Mohile) that recruited patients aged ≥70 with incurable cancer, their caregivers, and oncologists. Dyadic decision-making control preferences were measured by the Control Preferences Scale (CPS). Patients and caregivers were asked to describe patient's role in treatment decision-making (patient-role CPS); patients and caregivers were also asked to describe the caregiver's role in treatment decision-making (caregiver-role CPS). Matching patient-caregiver responses were considered concordant. Patients and caregivers were also asked about their information preferences regarding the amount of detail about the patients' illness using a scale from 1 (fewest detail) to 5 (the most detail). We used descriptive statistics to summarize CPS, informational preferences, and concordance in responses. We utilized logistic regression to assess dyads' sociodemographic information, patients' GA domain impairments, and physicians' practice characteristics associated with patient-caregiver CPS concordance. RESULTS: A total of 332 dyads participated; mean age (SD) of patients and caregivers was 76.6 (5.3) and 66.6 (12.2), respectively. Preferences for treatment decision-making varied, with some preferring shared decision-making and others preferring the doctor to make decisions. Concordance between patients and caregivers was observed in 46 % for patient-role CPS and 54 % for caregiver-role CPS. Baseline factors were not associated with dyad concordance. The majority of patients and caregivers preferred the most detailed information about the patient's illness. DISCUSSION: Clinicians should assess patients' and caregivers' informational and decisional control preferences for optimal support in decision-making.