Abstract
Reaching treatment decisions in oncology often involves trade-offs between quality of life and quality of quantity of life. Decisions are best informed by evidence and patients need to understand that their engagement in decision-making is desirable because frequently there is not one best treatment and their values, preferences, and goals are important in reaching shared treatment decisions.
In the screening context, screening may identify abnormality that is not cancer but still merit surgery. Some cancers detected by screening may have already metastasized, and the consequence of 'early detection' is extended survival with incurable disease, rather than normal life expectancy. In the adjuvant setting, not every person recommended treatment experiences disease recurrence even if they choose not to receive chemotherapy. Adjuvant treatment may be the standard of care, but patients need to understand that disease recurrence is possible, and the outcome may be extension of disease-free survival, and not disease elimination. In patients with metastatic cancer, systemic treatments at the best may cause tumour shrinkage and prolongation of survival, but some patients will derive no benefit and experience the side effects of chemotherapy.
The Institute of Medicine defined patient-centred care as 'care that is respectful of and responsive to individual patient preferences, needs and values' (Barry and Edgman-Levitan 2012, p.780). Involving patients in discussions about treatment options and reaching of shared treatment decision highlights the importance of doctors and patients working together to produce the best outcome possible. Shared decision-making is applicable to most clinical consultations. It is especially important in circumstances where the evidence does not strongly support a single clearly superior option or where a preference-sensitive decision is involved, that is, the decision is likely to be strongly influenced by patient's preferences and values (Hoffmann et al. 2014). Shared decision-making enables research evidence to be incorporated into discussions with the patient, with their preferences explored and considered in reaching a treatment recommendation.
In the screening context, screening may identify abnormality that is not cancer but still merit surgery. Some cancers detected by screening may have already metastasized, and the consequence of 'early detection' is extended survival with incurable disease, rather than normal life expectancy. In the adjuvant setting, not every person recommended treatment experiences disease recurrence even if they choose not to receive chemotherapy. Adjuvant treatment may be the standard of care, but patients need to understand that disease recurrence is possible, and the outcome may be extension of disease-free survival, and not disease elimination. In patients with metastatic cancer, systemic treatments at the best may cause tumour shrinkage and prolongation of survival, but some patients will derive no benefit and experience the side effects of chemotherapy.
The Institute of Medicine defined patient-centred care as 'care that is respectful of and responsive to individual patient preferences, needs and values' (Barry and Edgman-Levitan 2012, p.780). Involving patients in discussions about treatment options and reaching of shared treatment decision highlights the importance of doctors and patients working together to produce the best outcome possible. Shared decision-making is applicable to most clinical consultations. It is especially important in circumstances where the evidence does not strongly support a single clearly superior option or where a preference-sensitive decision is involved, that is, the decision is likely to be strongly influenced by patient's preferences and values (Hoffmann et al. 2014). Shared decision-making enables research evidence to be incorporated into discussions with the patient, with their preferences explored and considered in reaching a treatment recommendation.
| Original language | English |
|---|---|
| Title of host publication | Oxford Textbook of Communication in Oncology and Pallative Care |
| Editors | David W. Kissane, Barry D. Bultz, Phyllis N. Butow, Carma L. Bylund, Simon Noble, Susie Wilkinson |
| Place of Publication | Oxford UK |
| Publisher | Oxford University Press |
| Pages | 83-90 |
| Number of pages | 8 |
| Edition | 2nd |
| ISBN (Print) | 9780198736134 |
| Publication status | Published - 2017 |
Keywords
- metastatic cancer; communications skills program; shared decison making
