The Focus on Life-prolonging Anticancer Treatment Hampers Shared Decision-making in People with Advanced Cancer: A Qualitative Embedded Multiple-case Study

Overview

Journal Palliat Med

Publisher Sage Publications

Specialty Critical Care

Date 2024 Sep 28

PMID 39340169

Authors

Daisy Jm Ermers

Maartje J van Geel

Yvonne Engels

Demi Kellenaers

Anouk Sj Schuurmans

Floortje K Ploos van Amstel

Carla Ml van Herpen

Yvonne Schoon

Henk J Schers

Kris Cp Vissers

Evelien Jm Kuip

Marieke Perry

Affiliations

Soon will be listed here.

Abstract

Background: Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. To improve this, we conducted a quality improvement project, attempts to accomplish this by: (1) Integrating the patient's context into shared decision-making during consultation with the medical oncologist; (2) Actively involving the GP and case manager (a specialized oncology nurse), who often have knowledge about the patient's context, and; (3) Giving the person with advanced cancer a time-out period of up to 2 weeks to consider and discuss treatment options with others, including close family and friends.

Aim: To explore how persons with advanced cancer and their involved professionals experienced shared decision-making after the introduction of .

Design: A qualitative embedded multiple-case study using in-depth interviews analysed with inductive content analysis.

Participants: A purposive sample of 14 cases, each case consisting of a patient with advanced cancer and ideally their medical oncologist, case manager, and GP.

Results: Four themes were identified: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase.

Conclusions: The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making. This undermines integrating individual context into decision-making, a critical aspect of the palliative care continuum.

References

Elwyn G, Durand M, Song J, Aarts J, Barr P, Berger Z . A three-talk model for shared decision making: multistage consultation process. BMJ. 2017; 359:j4891. PMC: 5683042. DOI: 10.1136/bmj.j4891. View

Wieldraaijer T, de Meij M, Zwaard S, van Weert H, Wind J . Introducing a time out consultation with the general practitioner between diagnosis and start of colorectal cancer treatment: Patient-reported outcomes. Eur J Cancer Care (Engl). 2019; 28(6):e13141. PMC: 7074010. DOI: 10.1111/ecc.13141. View

Weiner S . Contextualizing medical decisions to individualize care: lessons from the qualitative sciences. J Gen Intern Med. 2004; 19(3):281-5. PMC: 1492155. DOI: 10.1111/j.1525-1497.2004.30261.x. View

Brom L, Pasman H, Widdershoven G, van der Vorst M, Reijneveld J, Postma T . Patients' preferences for participation in treatment decision-making at the end of life: qualitative interviews with advanced cancer patients. PLoS One. 2014; 9(6):e100435. PMC: 4070976. DOI: 10.1371/journal.pone.0100435. View

Tong A, Sainsbury P, Craig J . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6):349-57. DOI: 10.1093/intqhc/mzm042. View

Maskrey N . Shared decision making: why the slow progress? An essay by Neal Maskrey. BMJ. 2019; 367:l6762. DOI: 10.1136/bmj.l6762. View

Wallner L, Abrahamse P, Uppal J, Friese C, Hamilton A, Ward K . Involvement of Primary Care Physicians in the Decision Making and Care of Patients With Breast Cancer. J Clin Oncol. 2017; 34(33):3969-3975. PMC: 5477831. DOI: 10.1200/JCO.2016.67.8896. View

Malterud K, Siersma V, Guassora A . Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2015; 26(13):1753-1760. DOI: 10.1177/1049732315617444. View

Gaston C, Mitchell G . Information giving and decision-making in patients with advanced cancer: a systematic review. Soc Sci Med. 2005; 61(10):2252-64. DOI: 10.1016/j.socscimed.2005.04.015. View

10.

Herrmann A, Sanson-Fisher R, Hall A . Not having adequate time to make a treatment decision can impact on cancer patients' care experience: Results of a cross-sectional study. Patient Educ Couns. 2019; 102(11):1957-1960. DOI: 10.1016/j.pec.2019.06.011. View

11.

Belanger E, Rodriguez C, Groleau D . Shared decision-making in palliative care: a systematic mixed studies review using narrative synthesis. Palliat Med. 2011; 25(3):242-61. DOI: 10.1177/0269216310389348. View

12.

van de Pol M, Fluit C, Lagro J, Slaats Y, Olde Rikkert M, Lagro-Janssen A . Expert and patient consensus on a dynamic model for shared decision-making in frail older patients. Patient Educ Couns. 2016; 99(6):1069-77. DOI: 10.1016/j.pec.2015.12.014. View

13.

Rubin G, Berendsen A, Crawford S, Dommett R, Earle C, Emery J . The expanding role of primary care in cancer control. Lancet Oncol. 2015; 16(12):1231-72. DOI: 10.1016/S1470-2045(15)00205-3. View

14.

Sinclair C, Auret K, Evans S, Williamson F, Dormer S, Wilkinson A . Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention. BMJ Open. 2017; 7(2):e013415. PMC: 5337715. DOI: 10.1136/bmjopen-2016-013415. View

15.

Ayres L, Kavanaugh K, Knafl K . Within-case and across-case approaches to qualitative data analysis. Qual Health Res. 2003; 13(6):871-83. DOI: 10.1177/1049732303013006008. View

16.

Bomhof-Roordink H, Gartner F, Stiggelbout A, Pieterse A . Key components of shared decision making models: a systematic review. BMJ Open. 2019; 9(12):e031763. PMC: 6937101. DOI: 10.1136/bmjopen-2019-031763. View

17.

Waddell A, Lennox A, Spassova G, Bragge P . Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review. Implement Sci. 2021; 16(1):74. PMC: 8325317. DOI: 10.1186/s13012-021-01142-y. View

18.

Edwards M, Holland-Hart D, Mann M, Seddon K, Buckle P, Longo M . Understanding how shared decision-making approaches and patient aids influence patients with advanced cancer when deciding on palliative treatments and care: A realist review. Health Expect. 2023; 26(6):2109-2126. PMC: 10632651. DOI: 10.1111/hex.13822. View

19.

Kunneman M, Gravholt D, Hartasanchez S, Gionfriddo M, Paskins Z, Prokop L . Assessing collaborative efforts of making care fit for each patient: A systematic review. Health Expect. 2023; 26(4):1391-1403. PMC: 10349223. DOI: 10.1111/hex.13759. View

20.

Perfors I, Noteboom E, de Wit N, van der Wall E, Visserman E, van Dalen T . Effects of a time out consultation with the general practitioner on cancer treatment decision-making: a randomised controlled trial: Time out with the general practitioner and cancer treatment decision. Psychooncology. 2020; 30(4):571-580. PMC: 8048675. DOI: 10.1002/pon.5604. View