Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature

Covvey, Jordan R.; Kamal, Khalid M.; Gorse, Erin E.; Mehta, Z.; Dhumal, Trupti; Heidari, Elham; Rao, Deepika; Zacker, Christopher

doi:10.1007/s00520-019-04675-7

Cited by 128 publications

(128 citation statements)

References 49 publications

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“…A priori, a list of barriers and facilitators to SDM was generated from a review of relevant literature and used for a thematic analysis 10 11 25 26. Participants’ answers to both close- and open-ended questions were read and coded using the list.…”

Section: Methodsmentioning

confidence: 99%

Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

et al. 2020

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ObjectivesTo explore physicians’ and nurses’ knowledge, attitudes and experiences of shared decision making (SDM) in rheumatology, to identify barriers and facilitators to SDM, and to examine whether physicians’ and nurses’ perspectives of SDM differ.MethodsA cross-sectional, exploratory, online survey was used. Besides demographic characteristics, healthcare professionals’ knowledge, attitudes and experiences of SDM in rheumatology were assessed. Barriers and facilitators to SDM were identified from healthcare professionals’ answers. Descriptive statistics were computed and differences between physicians’ and nurses’ perspectives of SDM were examined with a t-test or Fisher’s exact test, as appropriate.ResultsBetween April and June 2019, 77 physicians and 70 nurses completed the survey. Although most healthcare professionals lacked a full conceptual understanding of SDM, almost all physicians (92%) and all nurses had a (very) positive attitude toward SDM, which was most frequently motivated by the belief that SDM improves patients’ treatment adherence. The majority (>50%) of healthcare professionals experienced problems with the application of SDM in clinical practice, mostly related to time constraints. Other important barriers were the incompatibility of SDM with clinical practice guidelines and beliefs that patients do not prefer to be involved in decision making or are not able to take an active role. Modest differences between physicians’ and nurses’ perspectives of SDM were found.ConclusionsThere is a clear need for education and training that equips and empowers healthcare professionals to apply SDM. Furthermore, the commitment of time, resources and financial support for national, regional and organisational initiatives is needed to make SDM in rheumatology a practical reality.

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Section: Methodsmentioning

confidence: 99%

Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

et al. 2020

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“…This, along with the unpredictability of the disease, led to some patients feeling like a ''passenger'' in relation to their care. This echoes the systematic review by Covvey and colleagues 6 that indicated that physician communication could act as a barrier to shared decision making, when done poorly, or a facilitator, when done well. While there might always be options available, how they are presented will likely influence whether patients perceive that there are viable options and how much influence they can or want to have in making those decisions, with some patients preferring to defer medical decision making to the doctor.…”

Section: Discussionmentioning

confidence: 52%

“…4 For patients, barriers to participating in decision making include lack of time and impersonal relationship with the physician, poor physician communication, the challenging physical environments in which conversations must take place, poor health literacy and concerns of adverse effects, and the imbalance of knowledge between the physician and patient. 5,6 Research on patient decision making has largely focused on decisions regarding treatment, or relating to a particular clinical encounter. 2,3,7,8 The definition and assumptions underpinning patient decision making have evolved over time.…”

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confidence: 99%

“…12 Patient decision making within oncology is particularly important to study as cancer care decisions can have life-altering physical and emotional consequences, and treatment options are continuously evolving. 6 Within oncology, there has been much research on preferences for decision-making participation, and barriers and facilitators to participation, often with a focus on choosing specific treatment. 13 Facilitating factors for patient engagement in cancer treatment decision making seem largely related to physician attitudes and subsequent behavior, such as consideration of patient preferences and the use of support systems or decision aids.…”

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confidence: 99%

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“Along for the Ride”: A Qualitative Study Exploring Patient and Caregiver Perceptions of Decision Making in Cancer Care

Holdsworth

Zionts

Asch

et al. 2020

MDM Policy & Practice

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Background. Shared decision making is a cornerstone of an informed consent process for cancer treatment, yet there are often many physician and patient-related barriers to participation in the process. Decisions in cancer care are often perceived as relating to a discrete, treatment decision event, yet there is evidence that decisions are longitudinal in nature and reflect a multifactorial experience. Objective. To explore patient and caregiver perceptions of the choices and decision-making opportunities within cancer care. Design. Qualitative in-depth interviews with 37 cancer patients and 7 caregivers carried out as part of an evaluation of a cancer center’s effort to improve patient experience. Results. Participants described decision making related to four distinct phases in complex cancer care, with physicians leading, and often limiting, decisions related to disease assessment and treatment options and access, and patients leading decisions related to physician selection. Though physicians led many decisions, patients had a moderating influence on treatment, such that if patients did not like options presented, they would reconsider their options and sometimes switch physicians. Patients had various strategies for dealing with uncertainty when faced with decisions, such as seeking additional information to make an informed choice or making a conscious choice to defer decision making to the physician. Limitations. Patients were sampled from one academic cancer center that serves a predominantly Caucasian, Asian, and Hispanic/Latino population and received complex treatment. Conclusion. Because of the complexity of cancer treatment, many patients felt as though they were a “passenger” in decision making about care and did not lead many of the decisions, though many patients trusted their doctors to make the best decisions and were comforted by their expertise.

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“…While five of these emphasized lung cancer, none evaluated regret. 5 In contrast, a 2016 systematic review of 59 studies dealing specifically with regret failed to find a single one focused on lung cancer. 6 In this current study, the frequency of regret was prospectively evaluated at three months after starting systemic treatment for advanced lung cancer.…”

Section: Introductionmentioning

confidence: 99%

Do Patients Regret Having Received Systemic Treatment for Advanced Non-Small Cell Lung Cancer: A Prospective Evaluation

et al. 2020

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Background. Thousands of patients annually receive treatment for advanced NSCLC, but little is known about their views on the decision to receive that treatment, or regret. This trial prospectively evaluated the incidence of regret and whether baseline characteristics, patient decisionmaking parameters, or clinical progress early in the treatment course predicts regret. Materials and Methods. Patients receiving systemic treatment for advanced NSCLC completed every 3-week PRO assessment using the electronic LCSS, including the 3-Item Global Index ("3-IGI," assessing overall distress, activities, and QL). A prespecified secondary aim was to determine the frequency of regret evaluated at three months after starting treatment. Patients were randomized to usual care, or enhanced care (which included use of the DecisionKEYS decision aid). Results. Of 164 patients entered, 160 received treatment and 142 were evaluable for regret. In total, 11.5% of patients, and 9% of their supporters expressed regret. Baseline characteristics did not predict regret; regret was rarely expressed by those who had a less than 20% decline or improvement in the 3-IGI PRO score after two treatment cycles. In contrast, when asked if they would make the same decision again, only 1% not having a 20% 3-IGI decline expressed regret, versus 14% with a 3-IGI decline (p=0.01). Conclusion. The majority of patients having regret were identified early using the PRO 3-IGI of the eLCSS-QL measure. Identifying patients at risk for regret allows for interventions, including frank discussions of progress and goals early in the treatment course, which could address regret in patients and their supporters. The Oncologist 2020;9999:• • Implications for Practice: This report documents prospectively for the first time the incidence of treatment-related regret in patients with advanced lung cancer, and outlines that risk of regret is associated with patient-determined worsening health status early in the course of treatment. Identifying patients at risk for regret early in treatment (before the 3rd cycle of treatment) appears to be crucial. Counseling at that time should include a discussion of consideration of treatment change and the reason for this change.

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Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature

Cited by 128 publications

References 49 publications

Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

“Along for the Ride”: A Qualitative Study Exploring Patient and Caregiver Perceptions of Decision Making in Cancer Care

Do Patients Regret Having Received Systemic Treatment for Advanced Non-Small Cell Lung Cancer: A Prospective Evaluation

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