Abstract
There is considerable evidence of problems with the quality of cancer care. Wide variation in rates of interventions suggests that cancer care decisions may not reflect the preferences of informed patients. To present a framework for systems support for improving the quality of decisions in cancer. We outlined the types of decisions faced by cancer patients and categorized them based on the level of evidence available about effectiveness of choices and the amount of variation in patients' preferences for the key outcomes. Then we describe appropriate strategies to systematically improve the quality of decision making for each category. The types of decisions faced by cancer patients and providers are varied. The appropriate strategy to drive improvements differs for different decisions. For complex, preference-sensitive decisions, improvements in decision quality require increasing patients' knowledge and the match between patients' preferences and treatments. Decision making in cancer care is complex. Neither patients nor providers can make treatment decisions alone. System support is needed to improve the quality of decisions.
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