LETTER
Eliciting Patient Preferences
Richard D. Callahan, MD
1 January 1993 | Volume 118 Issue 1 | Pages 76-77
TO THE EDITOR:
Levine and colleagues [1] have attempted to provide patients with unbiased information regarding the benefits and costs of adjuvant chemotherapy for breast cancer to allow patients to make personal choices. However, it may not be a totally rational decision. Unless one is practicing on the planet Vulcan, emotional factors are involved in decision making. Fifty-seven percent of the "healthy" volunteers opted for chemotherapy compared with 92% of the women actually threatened by breast cancer. Real fear and anxiety in patients who had just undergone surgery for breast cancer may well have motivated a greater number to elect treatment. This same fear and anxiety, combined with the human elements of denial and anger, may present a barrier that can block or distort the information transfer between the physician and patient.
It is difficult, if not impossible, to be totally objective when one's life is at stake. Most oncologists are familiar with this "selective hearing". Levine's otherwise excellent article does not seem to account for this fear factor. Also, although no ethical alternative seems to exist, the absence of this factor may undermine the validity of testing a patient-choice instrument.
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Author and Article Information
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Regional Oncology & Hematology Associates; Suite G-102; 445 Biltmore Avenue; Asheville, NC 28801
1. Levine M, Gafni A, Markham B, MacFarlane D. A bedside decision instrument to elicit a patient's preference concerning adjuvant chemotherapy for breast cancer. Ann Intern Med. 1992; 117:53-8.
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