EXPERT OPINION OF TREATMENT DECISION MAKING IN PATIENTS WITH EARLY STAGE NON-SMALL CELL LUNG CANCER

Purpose:

In the field of oncology, patient participation in treatment decision making (shared decision making (SDM)) has become the hallmark of patient-centered care. However, in lung cancer it has not been widely incorporated into routine clinical practice. This study aims to investigate the opinion of lung cancer clinicians concerning SDM in patients with early stage non-small cell lung cancer (NSCLC; treatment options: radiotherapy and surgery).

Method:

   A survey was conducted among Dutch cardio-thoracic surgeons/lung surgeons and pulmonologists. Clinician opinion on involvement of patients in SDM was assessed by using 1-5 Likert-scale and open questions. Opinion on choice of treatment strategies was assessed by seven hypothetical cases in which the clinician rated the likelihood of choosing a particular treatment using 1-7 Likert-scale.

Result:

   Sixty-seven medical specialists with mean experience of 14-years participated (46=surgeons, 21=pulmonologists). Most respondents agreed that patients should always be involved in SDM (pulmonologists 78% versus surgeons 65%;p=0.225) and 33% of pulmonologists versus 32% of surgeons indicated that they always apply SDM (p=0.279). However, they point out that SDM may not always be feasible due to low patient education-level and little knowledge concerning NSCLC. Most respondents found that ideally doctors and patients should decide together (pulmonologists=78%, surgeons=65%;p=0.912), and that the clinician can often decide for patients how risks and benefits should be weighed (pulmonologists=50% versus surgeons=60%;p=0.569).

   Thirty-three percent of pulmonologists versus 38% of surgeons indicated that doctors are not properly trained to implement SDM (p=0.493) as it is a feature that is learned in clinical practice. Forty-six percent found that more consultation time is needed to apply SDM properly and to have a good patient-clinician relationship. Furthermore, clinicians indicated that the multidisciplinary tumor board (MTB) meeting, where the preferred treatment strategy is determined by clinicians, before it is communicated to the patient, is leaving little room for consideration of patient preferences.

   The answers to the seven hypothetical patient cases are illustrated in Figure-1.

Conclusion:

   Although lung cancer clinicians agree that patient participation in SDM is important, they recognize in current practice several areas of improvement for effective SDM, such as patient knowledge, time constraints, and adequate implementation of SDM in the care path. The observed variation in clinician preferences for the different treatment options underlines the value sensitive nature of the treatment choices.