Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;38(10):1156-1168.
doi: 10.1177/02692163241281145. Epub 2024 Sep 27.

The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case study

Daisy Jm Ermers  1   2 , Maartje J van Geel  3 , Yvonne Engels  1 , Demi Kellenaers  1 , Anouk Sj Schuurmans  1 , Floortje K Ploos van Amstel  4 , Carla Ml van Herpen  4 , Yvonne Schoon  5 , Henk J Schers  2 , Kris Cp Vissers  1 , Evelien Jm Kuip  1   4 , Marieke Perry  2
Affiliations

The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case study

Daisy Jm Ermers et al. Palliat Med. 2024 Dec.

Abstract

Background: Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. To improve this, we conducted a quality improvement project, CONtext. CONtext attempts to accomplish this by: (1) Integrating the patient's context into shared decision-making during consultation with the medical oncologist; (2) Actively involving the GP and case manager (a specialized oncology nurse), who often have knowledge about the patient's context, and; (3) Giving the person with advanced cancer a time-out period of up to 2 weeks to consider and discuss treatment options with others, including close family and friends.

Aim: To explore how persons with advanced cancer and their involved professionals experienced shared decision-making after the introduction of CONtext.

Design: A qualitative embedded multiple-case study using in-depth interviews analysed with inductive content analysis.

Participants: A purposive sample of 14 cases, each case consisting of a patient with advanced cancer and ideally their medical oncologist, case manager, and GP.

Results: Four themes were identified: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase.

Conclusions: The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making. This undermines integrating individual context into decision-making, a critical aspect of the palliative care continuum.

Keywords: Shared decision-making; communication; medical oncology; palliative care; professional-patient relations; qualitative research.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Belanger E, Rodriguez C, Groleau D. Shared decision-making in palliative care: a systematic mixed studies review using narrative synthesis. Palliat Med 2011; 25(3): 242–261. - PubMed
    1. Gaston CM, Mitchell G. Information giving and decision-making in patients with advanced cancer: a systematic review. Soc Sci Med 2005; 61(10): 2252–2264. - PubMed
    1. Edwards M, Holland-Hart D, Mann M, et al. Understanding how shared decision-making approaches and patient aids influence patients with advanced cancer when deciding on palliative treatments and care: a realist review. Health Expect 2023; 26(6): 2109–2126. - PMC - PubMed
    1. Pollard S, Bansback N, Bryan S. Physician attitudes toward shared decision making: a systematic review. Patient Educ Couns 2015; 98(9): 1046–1057. - PubMed
    1. Weiner SJ. Contextualizing medical decisions to individualize care: lessons from the qualitative sciences. J Gen Intern Med 2004; 19(3): 281–285. - PMC - PubMed