Factors which motivate cancer doctors to involve their patients in reaching treatment decisions

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Abstract

Objective

Cancer patients increasingly expect to be involved in treatment decision-making. We investigated factors that motivate cancer doctors to involve their patients in treatment decisions.

Methods

We conducted 22 telephone interviews with doctors treating breast, colorectal, gynaecological, haematological or prostate/urological cancer. Interviews probed doctors for attitudes to shared decision-making (SDM), views of when patient involvement is appropriate and what motivated them to encourage involvement. Interviews were audio-recorded. Themes were identified using framework analysis.

Results

Cancer doctors described disease, patient, doctor and societal influences on their support for patient involvement in treatment decisions. Treatment recommendations were described as ‘clear-cut’ or ‘grey’. When treatment options were clear-cut, the impact of treatment on patients’ quality of life and self-image and the influence of consumer groups motivated doctors’ support of patient involvement.

Conclusion

Australian cancer doctors express differing support of patient involvement in decision-making dependent on context, impact and effect that involvement may have. Doctors described meeting patient involvement preferences as a challenge, and needing to identify different characteristics, anxiety levels and levels of understanding to guide them to involve patients in decisions.

Practice implications

Models of shared decision-making may warrant refinement to better guide doctors to elicit and discuss information and involvement preferences.

Introduction

Involving patients in reaching a treatment decision to the level they desire, promoted by using shared decision-making, is increasingly considered the standard of care. Models of shared decision-making support discussion of information and involvement preferences and discussion of treatment options for all [1]. The role that patients subsequently play in treatment decision-making can then reflect the preferences they express. Cancer patients’ preferences for information and involvement have been widely studied, while knowledge of cancer doctors’ views is limited. Yet the doctor usually sets the agenda and decides what and how much information to present; thus patients’ achievement of their information and involvement preferences in a consultation is affected by the willingness of their doctor to involve them in decision-making [2].

We found from a large survey of practicing Australian cancer doctors that use of shared decision-making (SDM) differed according to cancer specialisation (the specific cancers treated, e.g. breast, colorectal, gynaecological, haematological, prostate/urological) and clinician discipline (e.g. medical oncology, radiation oncology, surgery) despite most doctors reporting in our survey being very comfortable with this approach [3]. Patient, doctor and system barriers to uptake of SDM have been identified in the literature [4], [5]. We sought to identify from a subset of Australian cancer doctors, what influences them to involve their patients in reaching treatment decisions.

Section snippets

Data collection

We conducted 22 semi-structured telephone interviews between March and May 2007 with Australian cancer doctors to discover their views about involving patients in decision-making. We used telephone interviews due to the geographical spread of participants; furthermore the anonymity that telephone interviews provide enhances the quality of data collected, by increasing participants’ willingness to speak openly and reducing social desirability bias [6]. Our questions probed themes that emerged

Results

Four main themes emerged regarding factors that influence Australian cancer doctors to involve patients in decision-making, characteristics of the disease, the patient, the doctor and society.

Discussion

This qualitative study of Australian cancer doctors sought to explain the differences we found in our earlier study of reported clinician use of SDM with their patients.

The existence of treatment options appeared to be the most influential factor for doctor support of patient involvement. Most doctors in our study commented that SDM is most appropriate in situations of uncertainty or controversy. These types of decision have been labelled preference-sensitive situations [7]. In contexts where

Acknowledgements

We thank the 22 doctors who made time in their busy schedules to participate and consented to be audio-recorded for this study. Heather Shepherd is supported by a Postdoctoral Training Fellowship from the National Health and Medical Research Council of Australia (ID568962).

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