Examining Decision Making Styles in Patients with Lymphoma and Multiple Myeloma Considering Autologous Stem Cell Transplantation.

The assessment of the risks and benefits involved in autologous stem cell transplantation (ASCT) remains a challenging task commonly faced by patients (pts) with lymphoma, multiple myeloma (MM), and other cancers. Individuals’ decision-making styles can influence how pts evaluate complex treatment decisions.

Methods: To examine how pts with lymphoma and myeloma make treatment decisions we performed a pilot study in which we administered an 80-item questionnaire to assess pts’: Desired Role in decision making, Need for Cognition, Need for Structure, and General Decision Making style. During the visit, the physician and pt discussed possible treatment options, and a 38-item post-visit questionnaire was administered to assess patients’ strength of preference for ASCT, perceptions of physician and caregiver’s preferences, and decision satisfaction. Questions were derived from previously validated questionnaires and used 5-point Likert scales.

Results: Questionnaires were administered to 25 pts (9 aggressive NHL, 9 indolent NHL, 4 Hodgkin lymphoma, 1 MM, and 2 undergoing evaluation for lymphoma). 72% of pts were male and 68% were married with a median age for the group of 50 years (Range 22–83). Pts had received a median of 1 prior regimen (range 0–4). 36% of pts rated their current health as excellent/very good, 32% good, and 32% fair/poor. All pts completed all pre-visit questions. 76% of pts completed all post-visit questions. Most pts expressed a desire that doctors make treatment decisions alone (68% agree/strongly agree) or with pt input (72%). Fewer pts believed they should make treatment decisions alone (32%) or with a doctor’s input (48%). 64% of pts had high scores for rational decision making style, whereas 28% scored high for an intuitive style, and only 4% high for a spontaneous style of decision making (Distribution shown in table). However, few pts expressed a strong need for structure (16%) or need for cognition (4%) in their decision making process. 89% of pts felt satisfied with the information they received for decision making and satisfied and comfortable with their decision. However, 32% of pts wanted clearer advice.

Conclusions: Examining pts decision making styles during the process of care is feasible and can uncover pt characteristics that are relevant for improving treatment discussions. Pts in this sample tended to use rational decision making styles but wanted the physician to assume control for decision making. Additional studies are needed examine these factors in larger populations of lymphoma and MM pts, understand their associations with demographic variables, and design and test decision support systems that account for pt preferences .and help pts and hematologists with treatment selection.