Abstract
Cancer is a life-threatening disease, albeit the continued improvement in treatment strategies, there are still many uncertainties during the treatment process and the effectiveness. In the current healthcare settings, shared decision-making (SDM) or patients’ preference and values and participation have less frequently been incorporated in the medical decision-making process. SDM has been advocated in Taiwan since 2016. The aim of this study is to investigate patients’ experiences of participation in SDM. A qualitative research using in-depth interviews design to present the patient's experience of participating in SDM. Purposive sampling of cancer patients above 20 years old in a teaching hospital in Northern Taiwan from January 15<sup>th</sup> to April 30<sup>th</sup> in 2018 was recruited. A total of 25 patients were enrolled for face-to-face in-depth interview, a qualitative content analysis according Graneheim and Lundman. Three themes of experiences and feelings of SDM participation were summarized, i.e., difficulty in making major medical decision, professional support is the most important, and mutual expect in shared decision-making. Six subthemes are shocked by the diagnosis, layman with deficient knowledge of the medical conditions, sufficient information for decision-making, encouragement and support for motivation, one is the master of his own body, and regain confidence to make decisions and face the future. With the development of medical technology, there has been significant improvement in cancer prevention and treatment in recent years. Still, a considerable proportion of cancer patients showed poor response to conventional treatment or control therapies, by which patients prone to face difficulty in choosing treatment options. Shared decision-making is a process of patient autonomy in which patients are equipped with correct understanding of treatment options and are able to make quality decisions.
Highlights
Taiwan is the first in Asia to pass the Patient Right to Autonomy Act to protect patient rights in 2016. This act is stipulated to respect patient autonomy, to safeguard their rights to a good death, and to promote a harmonious patient-physician relationship, all of which could possibly be fulfilled via shared decision-making (SDM) [1]
The emotional distress may resulted from the information asymmetry between physicians and patients that patients are unfamiliar with medical treatment, and traditionally, medical decision-making is usually dominated by medical personnel and the patients are passive recipient of care [18]
In this study of interaction with cancer patients, we demonstrated the most common problem in decision-making, the patients’ hesitation to make the decision because they believed they are laymen to medical profession
Summary
Taiwan is the first in Asia to pass the Patient Right to Autonomy Act to protect patient rights in 2016 This act is stipulated to respect patient autonomy, to safeguard their rights to a good death, and to promote a harmonious patient-physician relationship, all of which could possibly be fulfilled via shared decision-making (SDM) [1]. Healthcare personnel should take 3Es into consideration, so as to implement SDM based on patients’ preferences as well as evidence-based medical recommendations [4, 5]. Along these lines, patient health literacy, understanding of risks and patient-physician relationship may be improved; whereas decisional conflicts, patients’ feeling of being uninformed and inappropriate inspection or treatment may be ameliorated [6]. Autonomy is a right rather than an obligation, and healthcare personnel has to figure out patient’s
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