Purpose: Previous research examines the nature of shared decisions in clinical encounters, but relatively little work focuses on understanding shared decision-making during surgical consultations. This project focuses on treatment consultations between surgeons and patients diagnosed with probable non-small cell lung cancer.
Method: Forty consultations between surgeons and patients are in the process of being audio-recorded and transcribed at an urban Midwest academic institution. These data are supplemented with pre and post consultation surveys of surgeon risk assessments and patient knowledge, health literacy, numeracy, beliefs and attitudes relevant to treatment decisions. Among other variables, each consultation transcript is coded for: 1) patient involvement (Elwyn’s Option Scale), 2) specific types of information exchanged (e.g. disagreements, confusion, question asking), and, 3) treatment decisions. Qualitative findings are linked with patient and surgeon survey data to understand how surgeon’s risk assessments and patients’ literacy, numeracy, and beliefs contribute to the nature of the consultation and the post-consultation assessment of the process.
Result: To date 7 patients (age 58-80) have completed surveys. Qualitative analyses of five transcripts show two types of decision-making patterns emerging. The first type, an “informational decision”, (n=3) consisted of two phases: 1) surgeon presents information, 2) patient accepts recommendation; decision is made. The second (n=2) “deliberation decision” showed three phases: 1) surgeon presents information; 2) patient expresses discord (confusion, disagreement, questioning) deliberation occurs; and 3) resolution is reached and a decision made. Preliminary findings corroborate the literature for the deliberation decision type. We extend the literature through our finding of the first decision-making pattern showing that surgeon-patient consultations are sometimes bereft of a ‘deliberation’ phase. Post-consultation survey data indicate that, even though all patients reported having received enough information, most did not believe that they understood the relevant risks. Preliminary analysis suggests that low health literacy and numeracy might play a role in patients’ limited understanding.
Conclusion: Surgeons and lung cancer patients’ consultations comprise at least two types of decision-making: an “informational decision” or a “deliberation decision” pattern. Preliminary results indicate that, even when patients claimed the information provided them was sufficient, their understanding of relevant risks was limited and this could be partially due to lower health numeracy and literacy. Findings from this project will help to understand and improve cancer treatment decision-making in the consultation.
See more of: The 33rd Annual Meeting of the Society for Medical Decision Making