Treatment Recommendations in Oncology Visits: Implications for Patient Agency and Physician Authority

Abstract

Although oncology is a major site for clinician‒patient treatment negotiation requiring a careful balance of potentially competing viewpoints, little is known about how clinicians promote their treatment recommendations to patients and what the manner of promotion tells us about the oncologist‒patient relationship. Utilizing an already-established schema of coding treatment recommendations, I draw on 61 treatment recommendations to examine treatment decision-making in oncology. This paper investigates how physicians balance asserting their authority while at the same time attending to patient agency and involvement in decision-making. Taking this one step further, this paper explores how physicians negotiate decision-making with patients given that they occupy a liminal state between obligations to policy imperatives and commitments to their professional knowledge and technical expertise. How do they do this, and what accounts for this? To answer these questions, this paper analyzes the ways in which physicians present treatment recommendations and the treatment contexts in which they are made.

Trust and shared decision‐making among individuals with multiple myeloma: A qualitative study

“…While there is growing consensus that shared decision‐making is necessary to patient‐centered care for individuals with serious and life‐limiting illness, 9 the best strategies to achieve shared decision‐making in practice remain elusive 10,11 . For effective shared decision‐making to occur, clinicians must be able to understand and effectively communicate the risks and benefits associated with various treatment options, while patients must feel empowered to communicate their goals and concerns 12 . Trust between patients and clinicians is essential in this context.…”

“… 10 , 11 For effective shared decision‐making to occur, clinicians must be able to understand and effectively communicate the risks and benefits associated with various treatment options, while patients must feel empowered to communicate their goals and concerns. 12 Trust between patients and clinicians is essential in this context.…”

Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System—A Mixed-Methods Study

“…Most of the interviewed physicians stated that they consider themselves responsible for choosing the most appropriate treatment for the patient, who expects this from the physician. Previous studies have already noted the prevalence of the tendency to give a physician full authority over treatment decisions [24,25]. It can be assumed that the gaps between the various age cohorts of physicians are related to broad processes that have changed the face of medicine, shifting from a paternalistic approach, according to which the physician knows what is best for the patient and should not be challenged, and moving to a liberal approach, which holds that patients are the best arbiters of their condition and should be placed at the center of decision making [26][27][28].…”

Managing “Stable” Cancer News

“…One particular problem and recurrent pattern in both primary and cancer care involves cutting diagnostic moments short by doctors' immediate shifts to treatment recommendations. Care could be improved if doctors invested the time to describe for patients and show concerns about stable as an acceptable or even best case scenario during the onset of treatment recommendations and during return visitations to create shared expectations for reasonable and attainable healing outcomes (Tate 2019). In short, the instability caused by stable news should not be overlooked or discounted but fully realized and addressed as partners in joint pursuit of healing.…”