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How are decisions made in cancer care? A qualitative study using participant observation of current practice
  1. Pola Hahlweg1,
  2. Martin Härter1,
  3. Yvonne Nestoriuc2,3,
  4. Isabelle Scholl1
  1. 1 Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2 Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  3. 3 Schön Klinik Hamburg Eilbek, Hamburg, Germany
  1. Correspondence to Dr Pola Hahlweg; p.hahlweg{at}uke.de

Abstract

Objectives Shared decision-making has continuously gained importance over the last years. However, few studies have investigated the current state of shared decision-making implementation in routine cancer care. This study aimed to investigate how treatment decisions are made in routine cancer care and to explore barriers and facilitators to shared decision-making using an observational approach (three independent observers). Furthermore, the study aimed to extend the understanding of current decision-making processes beyond the dyadic physician–patient interaction.

Design Cross-sectional qualitative study using participant observation with semistructured field notes, which were analysed using qualitative content analysis as described by Hsieh and Shannon.

Setting and participants Field notes from participant observations were collected at n=54 outpatient consultations and during two 1-week-long observations at two inpatient wards in different clinics of one comprehensive cancer centre in Germany.

Results Most of the time, either one physician alone or a group of physicians made the treatment decisions. Patients were seldom actively involved. Patients who were ‘active’ (ie, asked questions, demanded participation, opposed treatment recommendations) facilitated shared decision-making. Time pressure, frequent alternation of responsible physicians and poor coordination of care were the main observed barriers for shared decision-making. We found high variation in decision-making behaviour between different physicians as well as the same physician with different patients.

Conclusion Most of the time physicians made the treatment decisions. Shared decision-making was very rarely implemented in current routine cancer care. The entire decision-making process was not observed to follow the principles of shared decision-making. However, some aspects of shared decision-making were occasionally incorporated. Individual as well as organisational factors were found to influence the degree of shared decision-making. If future routine cancer care wishes to follow the principles of shared decision-making, strategies are needed to foster shared decision-making in routine cancer care.

  • shared decision-making
  • patient-centred care
  • cancer
  • oncology
  • qualitative research
  • participant observation

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Footnotes

  • Contributors PH was involved in planning of data collection, data collection, analysed and interpreted the data, and drafted the article. MH was involved in conception and design of the study, interpretation of the data and critical review of the manuscript. YN was involved in interpretation of the data and critical review of the manuscript. IS was involved in conception and design of the study, planning of data collection, data collection, data analysis, interpretation of the data and critical review of the manuscript. All authors reviewed the final version to be published.

  • Funding This work was supported by the German Research Foundation (grant number: SCHO 155/1-1).

  • Disclaimer The sponsors were not involved in the study design; in the collection, analysis and interpretation of data; nor in the decision to submit the paper for publication.

  • Competing interests MH declares that he is co-PI in a SDM research project funded by Mundipharma GmBH, a pharmaceutical company. IS conducted one physician training in shared-decision making within the research project funded by Mundipharma GmBH. The authors did not receive funding from Mundipharma GmBH for this paper, nor was the company involved in any steps of this study or publication process.

  • Patient consent Obtained.

  • Ethics approval The study was carried out in accordance with the Code of Ethics of the Declaration of Helsinki and was approved by the Ethics Committee of the Medical Association Hamburg (Germany).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data (in German language only) are available upon request for researchers after consultation with the corresponding author and the responsible Ethics Committee. Please contact the corresponding author if you wish to request the data set.

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