Exploring the decision‐making preferences of people with colorectal cancer

Abstract

Objectives To explore patient views on participation in treatment, physical care and psychological care decisions and factors that facilitate and hinder patients from making decisions.Design Qualitative study using semi-structured interviews with patients.Setting and participants Three NHS Trusts in the north-west of England. Theoretical sampling including 41 patients who had been treated for colorectal cancer.Results For patients, participation in the decision-making process was about being informed and feeling involved in the consultation process, whether patients actually made decisions or not. The perceived availability of treatment choices (surgery, radiotherapy, chemotherapy) was related to type of treatment. Factors that impacted on whether patients wanted to make decisions included a lack of information, a lack of medical knowledge and trust in medical expertise. Patients perceived that they could have a more participatory role in decisions related to physical and psychological care.Conclusion This study has implications for health professionals aiming to implement policy guidelines that promote patient participation and shared partnerships. Patients in this study wanted to be well informed and involved in the consultation process but did not necessarily want to use the information they received to make decisions. The presentation of choices and preferences for participation may be context specific and it cannot be assumed that patients who do not want to make decisions about one aspect of their care and treatment do not want to make decisions about other aspects of their care and treatment.

Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery

“…A previous study reported that patients with CRC wanted to be informed and involved in their care, but did not necessarily want to make any decisions. 1 Another small pilot study of patients with CRC found that more than two-thirds of participants preferred a passive decisionmaking role; however, 80% of patients in the study said that they had not been presented with any treatment alternatives. 26 We found similar results.…”

“…Previous studies have focused almost exclusively on the physician-patient interaction, with little, if any, emphasis on the impact of familial or cultural factors in the SDM process. [1][2][3][4][5][6][7][8][9][10][11][17][18][19][20][21][22][23][24][25][26][27][28] Patients in our cohort valued family as a crucial adjunct to the health care team, recognizing 3 specific roles for family members (collaborators, interpreters and supporters) that enable and influence decisionmaking while reducing the burden on patients and enhancing their overall experience. Consequently, within a model of patient-centred care, the involvement of family in patient decision-making is an important consideration for surgeons and other health care providers involved in their cancer care.…”

“…Treatment decision-making is particularly challenging for patients with colon cancer owing to the presence of substantial trade-offs between therapeutic effectiveness and post-treatment quality of life 1 in addition to the inherent risks associated with complex surgical procedures.…”

Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer

“…A major disadvantage of pre-operative chemotherapy is the potential for considerable delay before surgery for patients whose tumours prove resistant to Selecting patients for neo-adjuvant therapy and communicating evidence based information is clearly complex, particularly for women diagnosed with more aggressive and/or advanced cancers. It can be argued that surgery, cutting out the problem, is readily understood whereas systemic treatment is more complex to understand (Beaver, Jones, Susnerwala, Craven, Tomlinson, Witham et al 2005). It has been shown that breast care nurses (BCN) are an important source of information and support, helping women cope with their disease (Beaver, Tysver-Robinson, Campbell, Twomey, Williamson, Hindley et al 2009;Cruikshank, Kennedy, Lockhart, Dosser, Dallas 2008,).…”

Patient factors in the implementation of decision aids in general practice: a qualitative study

“…Previous qualitative research has shown that patientsÕ views about whether or not they were involved in decision making depended on a variety of factors for example, being informed and feeling involved in the consultation process and not necessarily taking on the responsibility of treatment selection. 26,27 The preference to delegate decision-making responsibility to clinicians was marked amongst heart disease and breast cancer patients. Previous research has shown that a significant proportion of patients with serious illnesses prefer to leave treatment decisions to their doctors.…”