Patient-Reported Roles in Decision-Making Among Asian Patients With Advanced Cancer: A Multicountry Study

<b>Purpose.</b> We investigated 1) perceived roles in decision-making among advanced cancer patients in 5 Asian countries 2) associations of patient characteristics with these roles, and 3) the association of perceived roles with quality of life and perceived quality of care. <b>Methods.</b> We surveyed 1585 patients with stage IV solid cancer. Multinomial logistic regressions were used to analyze associations of patient characteristics with decision-making roles. Multivariate regressions were used to analyze associations of decision-making roles with quality of life and care. <b>Results.</b> The most common perceived-role was no patient involvement. Most patients (73%) reported roles consistent with their preferences. Being male, nonminority, higher educated, aware of advanced cancer diagnosis, and knowledge of cancer diagnosis for ≥1 year were associated with higher levels of patient involvement in decision-making. Compared to no patient involvement, joint decision-making (together with physicians/family) was associated with higher social (β = 2.49, <i>P</i> < 0.01) and spiritual (β = 2.64, <i>P</i> < 0.01) well-being, and better quality of physician communication (β = 9.73, <i>P</i> < 0.01) and care coordination (β = 13.96, <i>P</i> < 0.01) while making decisions alone was associated with lower emotional (β = -1.43, <i>P</i> < 0.01), social (β = -2.39, <i>P</i> < 0.01), and spiritual (β = -2.98, <i>P</i> < 0.01) well-being. <b>Conclusions.</b> Findings suggest that a substantial number of advanced cancer patients were not (and preferred not to be) involved in decision-making. Despite this finding, joint decision-making together with physicians/family was associated with better quality of life and care. <b>Implications.</b> Physicians should explain the benefits of shared decision making to patients and encourage participation in decision-making, while ensuring that patients feel supported and do not find decision-making overwhelming.