REASON FOR ENCOUNTER: A MISSED OPPORTUNITY FOR SHARED DECISION MAKING

Purpose:

The first step in shared decision making is to make explicit to the patient that a decision needs to be made. The aim of this study is to assess oncologists’ statements concerning the reason for encounter, and the decision making process in (neo-) adjuvant treatment decision consultations.

Method:

Consecutive decision consultations between 1) radiation oncologists and rectal cancer patients, and 2) medical oncologists and breast cancer patients, were audiotaped. The tapes were transcribed and analysed using a self-developed coding instrument, coding whether, when, and how reason for encounter was mentioned, and whether a treatment decision was made. Coding was done by one coder after reaching high interrater-reliability with a second coder (kappa scores, 0.72-1.0).

Result:

Data collection is ongoing; currently 58 consultations have been coded and analysed, of which 29 with rectal cancer patients (15 male, 14 female) and 29 with breast cancer patients (all female). The mean age of the patients was 62 years (range, 42-87).

   In 46 (79%) consultations a reason for encounter was given, usually (90%) at the start of the consultation and initiated by the clinician (95%). In 33 (75%) consultations, clinicians indicated the reason for encounter to be to explain treatment option(s), which in most (97%) consultations actually happened. In one (2%) consultation, the clinician explicitly stated that a decision had to be made. A treatment decision was made in 40 (69%) consultations and significantly more often in consultations with breast than with rectal cancer patients (p<0.001). In 26 (65%) consultations the decision was made explicit, in eight (20%) was left implicit, and in six (15%) it was explicitly postponed. In the other 18 (31%) consultations the decision seemed to have been made before the start of the consultation.

Conclusion:

This study shows that oncologists miss opportunities to direct and attune patients to a role in the decision process during the consultation, and rather use that time to explain the treatment they have on offer.