Decision-making in the management of advanced cancer of the head and neck. Differences in perspective between doctors and patients: future avenues for research

Abstract

Twenty surgeons and 20 radiotherapists were questioned about the management of three theoretical patients with advanced cancers: 119 management plans were proposed, 46 of which were described as'palliative' in intent. Radiotherapywas the most common palliative therapy proposed (44%) and less than 10% involved supportive care only (i.e. involving no radiotherapy, chemotherapy or surgery). Radiotherapists were asked to rank 10 common symptoms, considered by the authors to be the most frequent and distressing in their patients, and these results were compared with ranking by a sample of 35 patients. All doctors considered symptom relief to be the most important aim of palliative therapy. There was variation as to which symptoms were perceived to be the most troublesome (and therefore in need of palliation) and a trend towards doctors overestimating the more objective 'treatable' symptoms and underestimating more subjective problems of anorexia and fear of growing cancer when patients and doctors were compared. Results suggest a need for more structured analysis of patients' concerns, clarification of the aims of therapy, and evaluation of outcome in the management of advanced head and neck cancer. The potential value of involving nurses in the initial decision-making process is discussed.