Barriers of and strategies for shared decision‐making implementation in the care of metastatic breast cancer: A qualitative study among patients and healthcare professionals in an Asian country

Abstract

Background Shared decision‐making has been shown to improve the quality of life in metastatic breast cancer patients in high‐literacy and high‐resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision‐making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision‐making is at the forefront. This paper aims to identify (1) barriers to practising shared decision‐making faced by healthcare professionals and patients and (2) strategies for implementing shared decision‐making in the context of metastatic breast cancer management in Malaysia. Methods We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi‐structured in‐depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. Results Five main themes emerged from the study: healthcare provider–patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision‐making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. Conclusion This study found that practising shared decision‐making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision‐making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider–patient barriers identified in this study. Patient or Public Contribution Patients were involved in the study design, recruitment and analysis.

Towards Agility in Breast Cancer Treatment Principles as Adopted from Agile Software Engineering

“…The research community reports the priority of having self-organized MDT; however, some factors may still hinder the effectiveness of these interactions, and these are reported to include leadership, individuals personality, cultural and belief systems, the need for regular clinical meeting, healthcare workers with double positions, availability of workforce, goals of care, implementation of national health insurance, hospital bureaucracy, issues with hospital infrastructure, patients, and high turnover. 80 , 161 , 162 Shared decision-making: as mentioned earlier, working together is much more than “policies, strategies, structures and processes”. 24 This is observed in involving patients, their families, BC experts, and other relevant parties in the exchange of significant information to assist in managing this complex therapy process.…”

“…The research community reports the priority of having self-organized MDT; however, some factors may still hinder the effectiveness of these interactions, and these are reported to include leadership, individuals personality, cultural and belief systems, the need for regular clinical meeting, healthcare workers with double positions, availability of workforce, goals of care, implementation of national health insurance, hospital bureaucracy, issues with hospital infrastructure, patients, and high turnover. 80 , 161 , 162 …”

Introducing Psychoeconomics of Healthcare Decisions: Understanding the Why behind Our Choices

“…• Tailoring Communication: Effective communication is crucial. Doctors can tailor their language to the patient's level of health literacy and ensure they understand the potential risks and benefits of various options (Lee et al, 2022). Shared decision-making, informed by psychoeconomic principles, empowers patients to take ownership of their healthcare.…”

Implications of Agile Values in Software Engineering for Agility in Breast Cancer Treatment: Protocol for a Comparative Study

“…As a result, this MDT communication approach with the patient enhances survival rates and improves quality of life [40][41][42][43][44]. Although the research community reports that the MDT and patient interaction are prioritized over processes, some barriers may still hinder the effectiveness of these interactions; these are reported to include absence of leadership, individual personalities, cultural and belief systems, the need for regular clinical meetings, health care workers with double positions, availability of the workforce, specific goals of care, implementation in national health insurance, hospital bureaucracy, issues with hospital infrastructure, patients themselves, and high turnover [44][45][46]. In the BCT context, collaborative decision-making constitutes far more than relying on factual information, as patient communication may generate a decision that contradicts the evidence; the evidence may suggest a different plan.…”