ONCOLOGIST AND PATIENT QUESTIONS DURING CONSULTATIONS ABOUT ADJUVANT CANCER TREATMENT: A SHARED DECISION-MAKING PERSPECTIVE

Purpose:

To assess the occurrence of questions that foster shared decision-making during consultation in which preference-sensitive decisions are discussed. Specifically, questions that foster cancer patients’ understanding of treatment decisions, and foster oncologists’ understanding of patients’ priorities.

Method(s):

Audiotaped pre-treatment consultations of 100 cancer patients with 32 oncologists about (neo-) adjuvant treatment were analysed using coding schemes to document question types, topics, and initiative. Patient and companion questions were combined. Two trained coders applied the schemes.

Result(s):

We assesses questions regarding a) understanding: what questions do oncologists ask about patients’ pre-existing knowledge, about information preferences and understanding, and what questions do cancer patients and companions ask about the disease and treatment; and b) regarding patient priorities: what questions do oncologists ask about patients’ treatment- and decision-related preferences.

   The oncologists ascertained prior knowledge in 50/100 patients, asked 24/100 about preferred (probability) information, and invited questions from 56/100 patients. The oncologists asked 32/100 patients about treatment preferences and/or for consent. Three-quarter of the patients asked about treatment harms and/or procedures, and 40/100 about treatment benefits.

Conclusion(s): It would be helpful to patients if oncologists more often assessed patients’ existing knowledge to tailor their information provision. Also, patients would receive treatment recommendations that better fit their personal situation if oncologists collected information on patients’ views about treatments. Moreover, patients may gain a better understanding of the choice they have if they were educated to ask questions about alternative treatment options, in addition to questions about those options on offer, and to ask questions about benefits and harms associated with options.