Barriers and Promoters to Participation in the Era of Shared Treatment Decision-Making

Abstract

This study aimed to identify the barriers and promoters for participation in cancer treatment decision in the era of shared decision-making (SDM) process. A qualitative design was utilized. Nineteen nurses and 11 nurse practitioners from oncology inpatient and outpatient settings participated in semi-structured interviews. Data were analyzed using directed content analysis. The findings include practice barrier, patient barrier, institutional policy barrier, professional barrier, scope of practice barrier, insurance coverage barrier, and administrative barrier. Multidisciplinary team approach, having a nursing voice during SDM, high level of knowledge of the disease and treatment, and personal valuation of SDM participation were perceived as promoters. Oncology nurses and nurse practitioners face many barriers to their participation during SDM. Organizational support and system-wide culture of SDM are essential to achieve better cancer treatment decisions outcome. Additional studies are needed to determine the factors that can promote more participation among nurses and nurse practitioners.

The role of hospital nurses in shared decision‐making about life‐prolonging treatment: A qualitative interview study

“…Therefore, such decisions require shared decision‐making (SDM), an approach for involving healthcare professionals’ evidence and expertise and patients’ values and preferences in treatment decision‐making (Charles, Gafni, & Whelan, 1997; Elwyn et al., 2017; Stiggelbout, Pieterse, & De Haes, 2015). Given their strong relationship with patients and unique expertise, nurses are increasingly considered important for and complemental to physicians’ role in treatment decision‐making (Buiting, Rurup, Wijsbek, van Zuylen, & den Hartogh, 2011; Elwyn et al., 2012; McCarter et al., 2016; McCullough, McKinlay, Barthow, Moss, & Wise, 2010). Importantly, patients want nurses to be involved (NFK, 2019) and report that nurses are valuable and influential in treatment decision‐making (McCarter et al., 2016; McCullough et al., 2010).…”

Shared decision-making when choosing the feeding method of patients with severe dementia: a systematic review

“…The review found no Brazilian studies, not even among excluded works. Some barriers to shared decision-making are common to many countries, such as time constraints on health care, resistance of health professionals due to the fear of loss of control in their relationship with the patient, and the belief that people do not want to be involved in decision-making about their health or do not have this ability and may make inappropriate decisions, putting themselves at risk, even in the presence of scientific uncertainty 7,21 .…”

Feasibility and effectiveness of tools that support communication and decision making in life-prolonging treatments for patients in hospital: a systematic review

“…44 The role of nurses is described elsewhere as educating patients about treatments and side effects, advocating on patients' behalf and coaching them in decision making, 12 15 49 50 and nurses are seen as valuable and influential in decision making about life-prolonging treatment. [51][52][53] The tools in the studies all involved written material. It can therefore be expected that their feasibility might be less in populations that might also be underrepresented in the study samples, such as adult migrant groups who are not native speakers of that language or people with limited health literacy.…”