N. Tamirisa1,2, A. Kandalam1, S. K. Linder1, S. Weller1, S. Turrubiate1, C. Silva1, T. S. Riall1 1University Of Texas Medical Branch,Surgery,Galveston, TX, USA 2University Of California – San Francisco,East Bay Foundation,Oakland, CA, USA
Introduction: Engaging patients in shared decision making involves: 1) A thorough patient understanding of the risks and benefits of treatment options and 2) Elicitation of patient preferences and treatment expectations at the time of decision making. Our aim was to explore patient and physician perceptions of shared decision making in clinical encounters for cancer care.
Methods: Twenty cancer patients with a range of cancer diagnoses, stages of cancer, and time from diagnosis and/or treatment participated in one-on-one interviews. Eight physicians, including surgeons, oncologists, gastroenterologists, and palliative care physicians, were interviewed. 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 analyzed for shared decision making themes. The number of patients and physician who mentioned specific themes were tallied with examples of themes given in quotations in Table 1.
Results: All physicians described providing information regarding treatment options, risks, and benefits (Table 1); 62.5% of physicians reported providing patients with written information. Concern for overwhelming patients with too much information, including prognostication, was mentioned by 37.5% of physicians. 80% of patients wanted to play an active role in the treatment decision. However, 50% of patients mentioned that written information provided was too detailed and not useful; 20% of patients felt that the physicians did not assess the level of information they wished to receive. To assist with treatment decisions, 75% of patients also wanted the physician’s recommendation including the option that a physician would choose for him/herself or family member in a similar situation. 62% of physicians incorporated patient autonomy in the shared decision making process but provided evidence-based data without framing treatment recommendations in the format preferred by most patients. 37.5% of physicians’ comments suggested a projection of their own values in making treatment recommendations.
Conclusion: 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 recommendations and inadvertently project their own priorities and values when communicating treatment options to patients. Better physician assessment of patients’ informational needs and development of their ability to elicit patients’ preferences will improve the shared decision making process in cancer patients.
