Patient-Centered Decision-Making in Metastatic Breast Cancer Care Delivery: A Call to Action

Abstract

P atient-centered care was most recently defined by the National Academy of Sciences in 2001 as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions." 1 Notably, this care approach counters a unidirectional, clinician-driven model where the clinician's voice and expertise is paramount. The introduction of the Patient Protection and Affordable Care Act in 2010 also heralded a major reform of the US health care delivery system, with an increased focus on patient-centered care delivery and research. 2,3 The subsequent impact on cancer care payment through oncology patient-centered medical homes; alternative payment models such as the Oncology Care Model and its successor, the Enhancing Oncology Care Model; along with comprehensive investment in research, has further demonstrated an increasing prioritization of patient engagement to improve cancer care outcomes. [2][3][4][5] Most recently, the US Department of Health and Human Services, in collaboration with the National Cancer Institute, released the National Cancer Plan roadmap, which is focused on 8 essential goals to improve the lives of people diagnosed with cancer, including delivery of evidence-based, patient-centered care. 6 Cornerstone to patient-centered care is a highly functional patient-clinician relationship that is based on a collaborative partnership that promotes bidirectional communication, empathy, respect, comfort, and perspective-sharing. [7][8][9] This partnership allows clinicians to better understand their patients as individuals with unique experiences, values, preferences, and care needs, and helps patients to better grasp their condition and evidence-based care options. 9 Further supporting a patient's early involvement in their health care, including identification of their care goals and treatment preferences, or the extent they wish to be involved in decisions (eg, shared or delegated to family or clinicians) is essential. 10 Metastatic breast cancer (mBC), an advanced and incurable form of breast cancer, 11 offers the opportunity to consider how a patient-centered approach can be operationalized in today's oncology care environment. Given the complex nature of an mBC diagnosis, care teams often comprise multiple specialists, and treatment choices require weighing risks and benefits. Prioritizing the patient-clinician relationship is essential for guiding clinical decisions and delivering high-quality care that aims to improve outcomes. 12 In 2022, a multidisciplinary working group comprising expert key partners in breast oncology, health services research, decision sciences, health literacy, and patient advocacy convened to form the Innovative Patient-Centered Decision-Making Consortium (I-PCDMC). Across 2 separate in-person meetings (July and October), the I-PCDMC discussed the current state of treatment decision-making in mBC care, including the key components of patient-centered decision-making (PCDM), best practices for...