Shared decision making in oncology practice: what do oncologists need to know?

Abstract

Background: There is growing interest by patients, policy makers, and clinicians in shared decision making (SDM) as a means to involve patients in health decisions and translate evidence into clinical practice. However, few clinicians feel optimally trained to implement SDM in practice, and many patients report that they are less involved than they desire to be in their cancer care decisions. SDM might help address the wide practice variation reported for many preference-sensitive decisions by incorporating patient preferences into decision discussions.

Methods: This paper provides a perspective on how to incorporate SDM into routine oncology practice to facilitate patient-centered communication and promote effective treatment decisions. Oncology practice is uniquely positioned to lead the adoption of SDM because of the vast number of preference-sensitive decisions in which SDM can enhance the clinical encounter.

Results: Clinicians can facilitate cancer decision making by: (a) determining the situations in which SDM is critical; (b) acknowledging the decision to a patient; (c) describing the available options, including the risks, benefits, and uncertainty associated with options; (d) eliciting patients' preferences; and (e) agreeing on a plan for the next steps in the decision-making process.

Conclusion: Given recent policy movements toward incorporating SDM and translating evidence into routine clinical practice, oncologists are likely to continue expanding their use of SDM and will have to confront the challenges of incorporating SDM into their clinical workflow. More research is needed to explore ways to overcome these challenges such that both quality evidence and patient preferences are appropriately translated and incorporated into oncology care decisions.

Figure 1.

Example of a pictograph often used to facilitate risk communication. In this image, risk can be described in the following way: “Our best estimate is that 25 of 100 people like you might experience nausea and/or vomiting after taking treatment A (as shown in the black-shaded rectangles), compared with 45 of 100 people who might experience nausea and/or vomiting after taking treatment B (as shown in the black-shaded and the blue-shaded rectangles). In other words, 20 additional people might experience nausea and/or vomiting after taking treatment B versus treatment A.”

Figure 2.

Example of a decision tool used to help prepare patients for oncology visits [39, 40, 60, 61].

Figure 3.

Screen shots from a Web-based decision aid, the Prostate Interactive Education System (PIES) [63]. Clicking on each link in the introduction brings viewers to a new page describing the background on prostate cancer, risk factors for prostate cancer, detection of prostate cancer, diagnosis of prostate cancer, tests performed, and treatment options. There are also individual decision guides for each of the treatment options (surgery, including robotic surgery and radical prostatectomy; radiation therapy, including brachytherapy; hormone therapy; cryotherapy; watchful waiting). The watchful waiting table of contents is shown in the lower screen shot.