The Balance of Patient Involvement: Patients’ and Health Professionals’ Perspectives on Decision-Making in the Treatment of Advanced Prostate Cancer

Abstract

Research has shown that involving patients in decisions on treatment may have positive effects for patients. However, there are different understandings of what involving patients implies and different attitudes among physicians toward sharing decisions with patients. This study aimed to explore the attitude of patients with advanced prostate cancer to involvement in treatment decisions and physicians’ and nurses’ approach to patient involvement. Moreover, it aimed to explore whether the decision-making changes as the treatment course progresses. Data were collected through participant observations and interviews. It was found that treatment decisions are primarily considered as part of physicians’ role. Physicians’ attitudes to patient involvement in treatment decisions depended on the type of treatment. Among patients and health professionals, there was a lack of confidence in the ability of patients to participate in the decisions. Health professionals and patients have different attitudes toward patient involvement and different views on what it entails.

Treatment decision making (TDM): a qualitative study exploring the perspectives of patients with chronic haematological cancers

“… 45 That patients with haematological malignancies, which are characterised by uncertain trajectories, indistinct transitions and prognostic uncertainty 7 46 47 and novel and evolving treatments, may prefer to defer decisions to specialists, whom they trust, is understandable. Our findings resonate with qualitative studies in Germany 48 and Denmark, 49 that combine interviews with extensive observation of consultations with clinicians and patients with cancer, and which show that most of the time physicians made treatment decisions alone, or with colleagues, with little patient involvement. None of our participants recalled clinicians formally eliciting their preferences regarding decision making, as is recommended, 50 51 yet most felt as involved in this process as they wanted to be, through discussions of treatment options, and clinicians taking time to talk and listen to them, address their concerns, answer questions and offer explanations.…”

Engagement With the Plan of Care Among Older Adults With Multiple Cardiac Diagnoses

“…Of course it is possible that the older adult had no more questions for the physician and simply understood and agreed with the plan of care, but the lack of negotiation can be seen as an attempt to avoid seeming impolite, not wanting to take the time of a busy professional, or not wanting to appear stupid in front of the knowledgeable (Spiers, 1998). Recent research (Lowe et al, 2021) supports the notion that patients see decision-making about treatment plans to be the role of the physician. Whatever the reason for the lack of negotiation observed, there is little evidence that shared decision-making happens with regularity in outpatient settings.…”

Shared decision‐making in standardized cancer patient pathways in Norway—Narratives of patient experiences

“…When deciding on treatment options, not all prostate cancer patients were offered a choice by their clinicians 7 . Another study found that treatment decisions were considered to be part of the physician's role as both healthcare professionals and patients doubted the latter's abilities to participate in decisions 24 . Therefore, treatment information was emphasized and amounted to patient involvement 24 .…”

“… 7 Another study found that treatment decisions were considered to be part of the physician's role as both healthcare professionals and patients doubted the latter's abilities to participate in decisions. 24 Therefore, treatment information was emphasized and amounted to patient involvement. 24 Studies on shared decision‐making for malignant melanoma trajectories are scarce, although it has been found that most melanoma patients prefer an active role and that implementing a shared decision‐making approach in clinics increased patient involvement.…”

“… 24 Therefore, treatment information was emphasized and amounted to patient involvement. 24 Studies on shared decision‐making for malignant melanoma trajectories are scarce, although it has been found that most melanoma patients prefer an active role and that implementing a shared decision‐making approach in clinics increased patient involvement. 25 With the implementation of standardized patient pathways in cancer care across countries, more knowledge is needed about how patients experience shared decision‐making in a standardized CPP.…”