How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer?

Katrin Reuter,Wolfgang Eich,Christiane Bieber,Kathrin Gschwendtner,Angela Buchholz,Jennifer Nicolai,Nicole Müller,Martin Härter,Birgit Kallinowski

doi:10.1007/s13187-016-1146-7

Abstract

The aims of this study are to assess patients’ preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients’ preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients’ 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification.Trial Registration: German Clinical Trials Register DRKS00000539; Funding Source: German Cancer Aid.

Highlights

Most cancer patients prefer collaborative roles with their oncologists in treatment decision making [9]
At least three approaches to medical decision making in which patients and physicians play different roles and that vary with regard to degree of patient autonomy have been described in the literature [7, 8, 12]
The situation for cancer patients in Germany appears to be even more desperate. In light of these findings, we explored the following questions: 1. How are patients’ preferred and perceived decisionmaking roles distributed among a sample of German breast and colon cancer patients?

Summary

Introduction

Most cancer patients prefer collaborative roles with their oncologists in treatment decision making [9]. J Canc Educ (2018) 33:708–715 address expectations, concerns and fears, deliberate on treatment and role preferences, and arrive at a joint decision [7, 8, 12] Another model is the paternalistic model, characterised by the lowest possible degree of patient autonomy. This model has been referred to as the Bpassive^ or Bdoctor-directed^ model because, under this approach, the physician alone decides, conveys his treatment decision to the patient, and takes sole responsibility for the treatment plan. The final model is the information model (or consumer model), which involves the highest possible degree of patient autonomy Under this model, the patient is the sole independent and responsible decision maker, making decisions after receiving complete medical information from the physician. This model has been referred to as the Bactive^ or Bpatient-directed^ model

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