Caregiving and Shared Decision Making in Breast and Prostate Cancer Patients: A Systematic Review

Abstract

Background: A cancer diagnosis can impact patients’ and caregivers’ lives, posing different challenging situations. In particular, breast cancer and prostate cancer are two types of cancer involving families and especially spouses in challenges linked with the diagnosis and treatment process. Caregivers are usually involved in the treatment decision-making (TDM) process concerning patients’ clinical pathway, cancer treatment, and ongoing therapies. To date, no contributions provide an exhaustive overview of the role of caregivers in cancer care and their involvement in the TDM process related to the therapies. Methods: We performed a systematic review of caregiver and patients experiences and perceptions of caregiver involvement in cancer TDM. Articles were searched on Public/Publisher MEDLINE (PubMed), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System Online (Medline), and American Psychological Association APA PsycINFO. Results: 17 studies were included, 10 on prostate cancer and 7 on breast cancer. According to the reviewed studies, patients and caregivers experienced the cancer diagnosis with a sense of unity. Most patients preferred to have an active or collaborative role with caregivers in TDM, feeling it was important to consult or share the decision made with their caregivers. Caregivers preferred to collaborate with patients or let patients decide by themselves after considering their opinions. Caregiver involvement could have a positive influence on the patient’s medical decisions, even if cancer diagnosis and treatments overwhelmed patients and caregivers. Conclusions: These findings highlight the importance of using a perspective that focuses on the relationship between a patient and caregivers when they receive a cancer diagnosis and have to make a treatment decision. Targeting caregiver–patient dyads, rather than individuals, is important since a supported relationship could have a protective effect on psychological distress, quality of life (QOL), and relationship satisfaction. Moreover, dyads may benefit from interventions that focus on the needs of both the patient and caregiver.

Survivorship care for people affected by advanced or metastatic cancer: MASCC-ASCO standards and practice recommendations

“…In the context of person-centered care for those with advanced or metastatic cancer, it is imperative to respect and support the goals and personal agency of survivors and their caregivers through a collaborative and shared decision-making process. Taking this approach ensures alignment with personal preference, despite having advanced or metastatic cancer, to have an active role in their cancer care and survivorship care provision [ 6 , 11 , 28 , 35 , 48 , 49 ]. However, the fluidity of preferences must be taken into consideration for people who may be facing progression of disease, changes of treatment regimen and declines in overall health status and self-management capabilities.…”

“…An integrated team-care approach involving specialists, nursing, primary care, social workers and allied health with early referral to multidisciplinary and interprofessional supportive care services significantly improves the timely coordination and delivery of quality care [ 11 , 12 , 14 , 20 , 21 , 24 – 26 , 36 , 49 , 56 , 57 , 58 ]. This also includes timely referral to specialist palliative/end-of-life care based on needs, which is associated with improved quality of life, psychosocial outcomes, physical symptoms, and period of survival [ 19 , 24 – 26 , 48 , 57 , 58 ]. In addition, people affected by advanced or metastatic cancer often are, or feel, excluded from existing survivorship programs and resources; and may also not feel ‘celebrating survivorship’ resonates with their experiences; thus, should be offered models of peer support, such as support groups and other community-led organizations specifically targeting this patient population.…”

“…This dual approach ensures that care encompasses the broad spectrum of support required to address the multifaceted challenges experienced by people with advanced or metastatic cancer and their caregivers. Further, evidence-based and comprehensive care with multidisciplinary involvement plays a pivotal role in actively encouraging and supporting informed decision making, ultimately improving health and disease management as well as distress reduction [ 6 , 11 , 12 , 14 , 20 , 25 , 28 , 48 , 57 ]. It is also fundamental that evidence-based practice encompass culturally sensitive care and information on supportive care strategies that is not only derived from and informed by research, but also tailored to be relevant to the local context of those receiving care [ 6 , 11 , 25 , 28 , 35 , 63 ].…”

The Effect of a Nurse-Led Family Involvement Program on Anxiety and Depression in Patients with Advanced-Stage Hepatocellular Carcinoma

“…Our nurse-led program facilitated family caregivers to become involved in decision making through providing and sharing information with the patient, coordinating care with medical doctors for consultation, and setting family meetings among the patient, family members, and healthcare providers. Patients often viewed their family members as supporters to help cope with cancer and treatment options and identify preferences [21] and mentioned that it was important to discuss or share any decisions made with their caregivers [48]. Therefore, these nursing activities would alleviate patients' psychological distress.…”

Relationship of Distress and Quality of Life with Gut Microbiome composition in Newly Diagnosed Breast Cancer Patients: a prospective, observational study

“…In clinical practice, healthcare providers should take steps to support patients in making informed decisions that are aligned with their goals and values. This may include providing clear and accurate information about treatment options, discussing the risks and bene ts of different treatments, and engaging in shared decision-making with patients and their families 32,33 .…”