Oncologist‐patient‐caregiver decision‐making discussions in the context of advanced cancer in an Asian setting

Abstract

Objective: Patient involvement in treatment decisions is recommended in clinicianpatient encounters. Little is known about how oncologists engage patients in shared decision making in non-Western countries. We assessed the prevalence of shared decision making among Singaporean oncologists and analysed how they discussed prognosis. Methods:We audio-recorded 100 consultations between advanced cancer patients and their oncologists. We developed a coding system to assess oncologist encouragement of patient participation in decision making and disclosure of an explicit prognosis. We assessed patient and oncologist characteristics that predicted these behaviours.Results: Forty-one consultations involved treatment discussions. Oncologists almost always listed more than one treatment option (90%). They also checked patient understanding (34%), discussed pros and cons (34%) and addressed uncertainty (29%).Oncologists discussed prognosis mostly qualitatively (34%) rather than explicitly (17%). They were more likely to give an explicit prognosis when patients/caregivers asked questions related to prognosis. Conclusion:Oncologists in our sample engaged their patients in decision making.They have areas in which they can improve to involve patients at a deeper level to ensure shared decision making. Findings will be used to develop an intervention targeting oncologists and patients to promote patient involvement in decision making. K E Y W O R D S cancer, decision making, patient participation, prognosis | 221 MALHOTRA eT AL. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Malhotra C, Kanesvaran R, Kumarakulasinghe NB, et al. Oncologist-patient-caregiver decision-making discussions in the context of advanced cancer in an Asian setting. Health Expect. 2020;23:220-228.

Lifestyle and Symptom Management Needs: A Network Analysis of Family Caregiver Needs of Cancer Patients

“…The high topological and conceptual overlap within medical needs suggest that FCCs work diligently to look after their loved ones and provide the best possible care for their care recipient. This result also supports previous studies that demonstrated the involvement of family members in cancer caregiving in Asian societies ( 41 ). Duty and filial piety are drivers for FCCs to strive to provide the best possible care for their care recipients, including finding the best medical options for them.…”

Validation of the Needs Assessment of Family Caregivers-Cancer scale in an Asian population

“…Therefore, this may have contributed to the low- or near-zero correlations between depression symptoms and medical unmet needs. Furthermore, cancer care in Singapore often involves patients and family members in medical consultations and support is extensive throughout the cancer journey [ 52 , 53 ]. Furthermore, in Singapore and many Asian societies, major decision-making instances often involve family members as family members often feel responsible as part of the family unit (further discussed below) [ 52 ].…”

“…Furthermore, cancer care in Singapore often involves patients and family members in medical consultations and support is extensive throughout the cancer journey [ 52 , 53 ]. Furthermore, in Singapore and many Asian societies, major decision-making instances often involve family members as family members often feel responsible as part of the family unit (further discussed below) [ 52 ]. Together with the confidence in healthcare providers [ 54 ], these factors may have mitigated the association between FCG medical unmet needs and depression symptoms.…”

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Adapting ENABLE for patients with advanced cancer and their family caregivers in Singapore: a qualitative formative evaluation

“…Notwithstanding the central role of the family in medical decision making, various decision-making styles were represented in our sample, including patient-directed and shared decision-making approaches [ 31 ]. While some patients would defer treatment discussions to their family, others in the same geographical context may advocate for an informed and activated patient who has productive interactions with the healthcare team, and adopt a shared decision-making approach [ 32 ]. Therefore, healthcare decision making approaches need to be tailored to individual family dynamics in the ENABLE-SG model.…”