Module 4.4 Consider the point of view of your patient

Health professionals can make recommendations in line with the evidence, but patients also have views on their healthcare which affect their choices and compliance. Failure to consider the patient’s viewpoint may compromise treatment as well as relationships.

Values

• Consider if your patient is likely to be compliant with the treatment and the ideal duration of the treatment.
  • Assess whether your patient will attend investigations needed to monitor a treatment response.
  • Discuss and negotiate follow-up requirements for treatment or investigations.
• Consider that your patient may have cultural beliefs and practices around medicine.
  • These practices can often be underfunded and under published.

Preferences

• Patient buy-in is much more likely if they have a clear picture of the risks and benefits as they apply to them. This is particularly true for interventions where the benefits are not immediately obvious to the patient, such as treatment of hypertension, hypercholesterolemia, or adjuvant chemotherapy for resected cancers.
• Different patients may place a different weight on the importance of future illness versus current costs and toxicities, and may trade-off one against the other in different ways.
• Remember that patients’ preferences may be different from those of health care professionals. Discordant preferences do not mean the clinician is right and the patient is wrong. Declining treatment does not always mean that the patient does not fully understand the risks and benefits of a clinical option.

Patient preferences in the spotlight

• Published studies have explored the preferences of patients who have had a treatment or intervention and have identified what benefits patients are prepared to accept in order to undergo the side effects and inconveniences of certain treatments. (1)
• Women with early breast cancer were asked what benefits they would require from their adjuvant chemotherapy in order to consider it worth the side effects and inconveniences. The majority of women considered much smaller benefits necessary than did the clinicians who treat early breast cancer. (2)
• The finding that patients with cancer are more likely to opt for aggressive, toxic treatment than people without cancer or health professionals has been replicated in a number of studies. (1, 3)

1 Wöckel, A., Park-Simon, TW., Korfel, A. et al. Preferences of patients with high-risk HR + /HER2- breast  cancer for adjuvant endocrine treatment: an adaptive choice-based conjoint analysis study from Germany. Breast Cancer Res Treat. 2025;211, 59–69.
2 Hamelinck VC, Bastiaannet E, Pieterse AH, et al. A Prospective Comparison of Younger and Older Patients’ Preferences for Adjuvant Chemotherapy and Hormonal Therapy in Early Breast Cancer. Clinical Breast Cancer. 2016;16(5):379–88.
3 Zhang M, He X, Wu J, Xie F. Differences between physician and patient preferences for cancer treatments: a systematic review. BMC Cancer. 2023;23(1).

Alternatives

• Determine whether an alternative intervention or test would be more appropriate or acceptable for your patient.
• Does another intervention have a different toxicity profile that would be safer or fit better with your patient’s values and preferences?
• Consider whether your patient would implement lifestyle changes instead of medication.
• Ask yourself if doing nothing is an option for your patient.

Outcomes

• Consider whether the outcomes are appropriate for your patient.
• Ask  your patient or yourself  if the outcomes matter to them.
  • Enough to take lifelong treatment? Injections? Therapy with significant short- or long-term toxicities?
• Assess if your patient is willing to have an invasive test or procedure.
• Reflect on whether your patient would proceed with further treatment or testing if the result of the test you are considering was positive/negative.