Patient and physician views of shared decision making in cancer

• Published in: Health expectations : an international journal of public participation in health care and health policy 2017-12, Vol.20 (6), p.1248-1253
• Main Authors: Tamirisa, Nina P., Goodwin, James S., Kandalam, Arti, Linder, Suzanne K., Weller, Susan, Turrubiate, Stella, Silva, Colleen, Riall, Taylor S.
• Format: Article
• Language: English
• Subjects: Autonomy; Bias; Breast cancer; Cancer; Cancer patients; Care and treatment; Cervical cancer; Clinical decision making; Clinical medicine; Codes; Communication; Decision analysis; Decision Making; Elicitation; Female; Group decision making; Health care facilities; Humans; Interviews; Interviews as Topic; Male; Medical centers; Medical diagnosis; Medical personnel; Melanoma; Metastasis; Neoplasms - therapy; Original Research Paper; Original Research Papers; Pancreatic cancer; Patient education; Patient Outcome Assessment; Patient Preference; Patient Protection & Affordable Care Act 2010-US; Patient Satisfaction; Patient-centered care; Patients; patient‐centered outcomes research; Perceptions; Physician-Patient Relations; Physicians; Physicians - psychology; treatment; Treatment preferences; Writing
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.12564

Context Engaging patients in shared decision making involves patient knowledge of treatment options and physician elicitation of patient preferences. Objective Our aim was to explore patient and physician perceptions of shared decision making in clinical encounters for cancer care. Design Patients and physicians were asked open‐ended questions regarding their perceptions of shared decision making throughout their cancer care. Transcripts of interviews were coded and analysed for shared decision‐making themes. Setting and participants At an academic medical centre, 20 cancer patients with a range of cancer diagnoses, stages of cancer and time from diagnosis, and eight physicians involved in cancer care were individually interviewed. Discussion and conclusions Most physicians reported providing patients with written information. However, most patients reported that written information was too detailed and felt that the physicians did not assess the level of information they wished to receive. Most patients wanted to play an active role in the treatment decision, but also wanted the physician's recommendation, such as what their physician would choose for him/herself or a family member in a similar situation. While physicians stated that they incorporated patient autonomy in decision making, most provided data without making treatment recommendations in the format preferred by most patients. We identified several communication gaps in cancer care. While patients want to be involved in the decision‐making process, they also want physicians to provide evidence‐based recommendations in the context of their individual preferences. However, physicians often are reluctant to provide a recommendation that will bias the patient.