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