Barriers to shared decisions in the most serious of cancers: a qualitative study of patients with pancreatic cancer treated in the <scp>UK</scp>

Ziébland, Sue; Chapple, Alison; Evans, Julie

doi:10.1111/hex.12319

Cited by 45 publications

(33 citation statements)

References 30 publications

(27 reference statements)

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“…Other research shows that presenting the decision as a fact and not mentioning alternative options are common behaviours [31,32]. An alternative option, or even 'doing nothing', may come only into view only if patients are not eligible for a certain treatment [33]. We showed in a study on adjuvant cancer treatment that in only 3% of consultations it was stated that a (preference-sensitive) decision needed to be made.…”

Section: Are the Four Sdm Steps Implemented In Clinical Practice?mentioning

confidence: 90%

Shared decision making: Concepts, evidence, and practice

Stiggelbout

Pieterse

Haes

2015

Patient Education and Counseling

617

607

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Section: Are the Four Sdm Steps Implemented In Clinical Practice?mentioning

confidence: 90%

Shared decision making: Concepts, evidence, and practice

Stiggelbout

Pieterse

Haes

2015

Patient Education and Counseling

617

607

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“…Another reason for the divergence in perception might be due to patients reporting that there was no choice to be made, as reported elsewhere [18,19]. Ziebland et al and Charles et al found patients commenting that there was no decision to be made if there was only one treatment option [18,19].…”

Section: Discussionmentioning

confidence: 98%

Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision

et al. 2020

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Increasingly, patients with advanced ovarian cancer in bowel obstruction are receiving home parenteral nutrition (HPN). Little is known about making and implementing the decision. This study explored the decision-making process for HPN and investigated the barriers and facilitators to implementation. This was a qualitative study underpinned by phenomenology involving 93 longitudinal in-depth interviews with 20 patients, their relatives and healthcare professionals, over 15 months. Participants were interviewed a maximum of four times. Interview transcripts were analysed thematically as per the techniques of Van Manen. We found variance between oncologists and patients regarding ownership of the HPN decision. The oncologists believed they were engaging in a shared decision-making process. However, patients felt that the decision was oncologist-driven. Nevertheless, they were content to have the treatment, when viewing the choice as either HPN or death. In implementing the decision, the principal mutable barrier to a timely discharge was communication difficulties across professional disciplines and organisations. Facilitators included developing a single point-of-contact between organisations, improving communication and implementing standardised processes. Oncologists and patients differ in their perceptions of how treatment decisions are made. Although patients are satisfied with the process, it might be beneficial for healthcare professionals to check patients’ understanding of treatment.

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“…, Ziebland et al . ). The research team had extensive discussions about the rationale and meaning of the interview items to ensure comparable data were collected.…”

Section: Methodsmentioning

confidence: 97%

The convivial and the pastoral in patient–doctor relationships: a multi‐country study of patient stories of care, choice and medical authority in cancer diagnostic processes

MacArtney

Andersen

Malmström

et al. 2020

Sociology Health & Illness

Self Cite

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Experiences of cancer diagnosis are changing in light of both the increasingly technological-clinical diagnostic processes and the socio-political context in which interpersonal relations take place. This has raised questions about how we might understand patient-doctor relationship marked by asymmetries of knowledge and social capital, but that emphasise patients' empowered choices and individualised care. As part of an interview study of 155 participants with bowel or lung cancer across Denmark, England and Sweden, we explored participants' stories of the decisions made during their cancer diagnostic process. By focusing on the intersections of care, choice and medical authoritya convivial pastoral dynamic we provide a conceptual analysis of the normative ambivalences in people's stories of their cancer diagnosis. We found that participants drew from care, choice and medical authority to emphasise their relationality and interdependence with their doctors in their stories of their diagnosis. Importantly negotiations of an asymmetrical patient-doctor relationship were part of an on-going realisation of the healthcare processes as a human endeavour. We were therefore able to draw attention to the limitations of dichotomising emancipatory-empowerment discourses and argue for a theorisation of the patient-doctor relationship as a contextually bounded and relationally ambivalent humanity. Notes1 The authors recognise the potential rupture of using conviviality outside of the studies of race and racism studies and considered developing alternative conceptualisations. However, it was felt this would be both academically inappropriate and an injustice to the inspiration and work of those cited as well as the wider field of cultural studies from which it was drawn.

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Barriers to shared decisions in the most serious of cancers: a qualitative study of patients with pancreatic cancer treated in the UK

Cited by 45 publications

References 30 publications

Shared decision making: Concepts, evidence, and practice

Shared decision making: Concepts, evidence, and practice

Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision

The convivial and the pastoral in patient–doctor relationships: a multi‐country study of patient stories of care, choice and medical authority in cancer diagnostic processes

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