Role of GPs in shared decision making with patients about palliative cancer treatment: a qualitative study in the Netherlands

Abstract

Background: General practitioners (GPs) are well-positioned to enhance shared decision-making (SDM) about treatment for patients with advanced cancer. However, to date, little is known about GPs’ views on their contribution to SDM. 
Aim: To explore GPs’ perspectives on their role in SDM about palliative cancer treatment and the preconditions to fulfil this role. Design and setting: Qualitative interview study among Dutch GPs. Method: GPs were sampled purposefully and conveniently. In-depth semi-structured interviews were conducted, recorded and transcribed verbatim. The transcripts were analysed by thematic analysis. Results: Most GPs reported practices that potentially support SDM: checking the quality of a decision, complementing SDM and enabling SDM. Even though most GPs felt that decision-making about systemic cancer treatment is primarily the oncologist’s responsibility, they do recognise their added value in the SDM-process because of their gatekeeper position, the additional opportunity they offer patients to discuss treatment decisions and their knowledge and experience as primary healthcare provider at the end of life. Preconditions for supporting the SDM-process were 1) good collaboration with oncologists, 2) sufficient information about the disease and its treatment, 3) sufficient time, 4) a trusting relationship with patients and 5) patient-centred communication. Conclusion: GPs may support SDM by checking the quality of a decision and by complementing and enabling the SDM-process to reach high quality decisions. This conceptualisation may help understand how SDM is carried out through interprofessional collaboration and provide tools for how to adopt a role in the interprofessional SDM-process.

Attitudes Toward Striving for Quality and Length of Life Among Patients With Advanced Cancer and a Poor Prognosis

“…53 Besides oncologists, nurses and general practitioners can support SDM by deliberating patients' goals during the illness trajectory. 82,83 Addressing patients' coping style and emotions may additionally help to actualize high-quality, goal-concordant care throughout the last phase of life.…”

“…53 Besides oncologists, nurses and general practitioners can support SDM by deliberating patients' goals during the illness trajectory. 82,83 Addressing patients' coping style and emotions may additionally help to actualize high-quality, goalconcordant care throughout the last phase of life. We used mixed linear modeling with two levels, since inclusion of a third level (oncologists) did not improve model fit and the ICC was low (ICC LL 5 0.00).…”

Shared decision-making in palliative cancer care: A systematic review and metasynthesis

“…42,48,57,58 Some of the included studies showed that being involved in early decision-making about palliative treatment could build a relationship for future end-of-life discussions, and, as situations changed, physicians and nurses revisited previous information and engaged with people with cancer and their families to reflect on the current situation. 53,[58][59][60] Also, with limited expected benefit of treatment, more room was given to considerations of patients' preferences, as De Snoo-Trimp et al 44…”

“…Firstly, they may motivate and promote patient involvement, and create awareness of choice. 43,58,60,61 As above, perceptions and awareness of equal choices can be limited, but one study 60,61 found that nurses can enable this. Bos-van den Hoek et al 61…”

“…43,51 The patient-physician dyad is central, and people with cancer, nurses and other healthcare professionals perceive that other health care professionals generally have limited roles in shared decision-making. 43,45,46,48,50,[59][60][61] However, other healthcare professionals facilitate and support shared decision-making in several ways.…”