Abstract Topic: 35. Quality of life and palliative care
Background: Effective shared decision-making incorporates patients’ goals, values, and preferences alongside clinical factors and other considerations.
Aims: We aimed to describe differences in patient preferences regarding treatment decision roles, communication styles, goals, and other determinants of decision-making between Black patients (BP) and White patients (WP) with multiple myeloma (MM).
Methods: A survey was conducted with adult patients recruited from online MM patient support communities in the US between 9/2022 and 11/2022. Survey items were informed by a targeted literature review, qualitative interviews, and a steering committee of clinical experts, patients, and a caregiver representative. Descriptive statistics were generated, reported in aggregate, and stratified by race.
Results: Of the 126 patients who completed the survey, 86 (68%) identified as WP and 30 (24%) as BP. A higher proportion of WP than BP reported being referred to a MM specialist upon diagnosis (56% vs 40%); 33% of BP were referred after their first or second relapse. Patients in both groups reported similar time spent by their physicians providing information about MM treatment. 47% and 22% of BP and WP, respectively, preferred that the physician have a greater role in deciding on MM treatments than themselves. 40% of BP preferred a shared role vs 50% of WP, while 27% of BP and 43% of WP felt they had shared involvement (Table). Duration of response and quality of life (QoL) were the most important treatment attributes for all patients. Of the other ranked treatment attributes (lower score = higher rank), risk of side effects and death from treatment were more important to WP (mean, 2.9 WP vs 5.1 BP), while administration route (6.7 WP vs 5.9 BP) and need for monitoring (7.3 WP vs 5.0 BP) were more important to BP. Both BP and WP indicated they would prefer better future health over better present health, but BP showed a preference toward length of life while WP showed a preference toward QoL. The ability to work or earn money, treatment anxiety, and spiritual/cultural background were among the factors that were more important to BP than to WP when making treatment decisions.
Summary/Conclusion: BP and WPs with MM place different importance on their roles and key attributes considered in treatment decision-making. Findings suggest that physicians demonstrate bias by taking a greater role, versus shared involvement, in decision-making with BP. Physicians should consider differences in personal values and preferences of patients from different racial backgrounds as they approach MM treatment discussions with patients.
Keywords: Multiple myeloma, Patient, Race, Real world data