Implementing and evaluating shared decision making in oncology practice

Abstract

Engaging individuals with cancer in decision making about their treatments has received increased attention; shared decision making (SDM) has become a hallmark of patient-centered care. Although physicians indicate substantial interest in SDM, implementing SDM in cancer care is often complex; high levels of uncertainty may exist, and health care providers must help patients understand the potential risks versus benefits of different treatment options. However, patients who are more engaged in their health care decision making are more likely to experience confidence in and satisfaction with treatment decisions and increased trust in their providers. To implement SDM in oncology practice, physicians and other health care providers need to understand the components of SDM and the approaches to supporting and facilitating this process as part of cancer care. This review summarizes recent information regarding patient and physician factors that influence SDM for cancer care, outcomes resulting from successful SDM, and strategies for implementing SDM in oncology practice. We present a conceptual model illustrating the components of SDM in cancer care and provide recommendations for facilitating SDM in oncology practice.

Process of allogeneic hematopoietic cell transplantation decision making for older adults

“…Low health literacy and high emotions impede the understanding of information. Demands on providers limit the time they can spend with any one patient, 45 and what the physician communicates and what the patient hears and remembers can differ greatly. 11,31,46,47 Furthermore, physician training has historically not included communication skills, though this may be beginning to change.…”

“…11,31,46,47 Furthermore, physician training has historically not included communication skills, though this may be beginning to change. 45 It is a challenging setting for clear dialogue between the patient/family and the members of their treatment team.…”

“…Alternative options with less burden than alloHCT are reasonable for older adults and need to be presented as such. 45 These options include supportive therapy (transfusions, antibiotics as needed, easily administered oral medications, SC injections at home or less frequent IV chemotherapies). Medicine needs to progress quickly to better understand outcomes in older adults.…”

“…This team approach to educating the patient has been suggested for cancer, surgical and dialysis patients as well as for a general patient education protocol. 45,[65][66][67] In addition, web-based programs, 12,45 Q&A groups, and other formats could be used to present the information. In partnership with three transplant centers, the National Marrow Donor Program/Be the Match is conducting a qualitative study to identify HCT-related information needs and learning preferences for older adult patients and their caregivers.…”

Do patients want choice? An observational study of neurology consultations

“…This may reflect differences across demographic subgroups and patients' presenting complaints. For instance, a review of SDM in oncology concluded that, overall SDM is associated with better outcomes and greater patient satisfaction, however there may be variability across patient groups and cancer types with respect to how involved patients want to be in decision-making processes [16].…”