Abstract
BackgroundShared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices–namely, communicating potential harms and benefits and discussing what matters to patients–occur in usual care.MethodsWe invited a convenience sample of clinicians and patients in a radiation oncology clinic to participate in a mixed methods study. Prior to consultations, clinicians and patients completed self-administered questionnaires. We audio-recorded consultations and conducted qualitative content analysis. Patients completed a questionnaire immediately post-consultation about their recall and perceptions.Results11 radiation oncologists, 4 residents, 14 nurses, and 40 patients (55% men; mean age 64, standard deviation or SD 9) participated. Patients had a variety of cancers; 30% had been referred for palliative radiotherapy. During consultations (mean length 45 min, SD 16), clinicians presented a median of 8 potential harms (interquartile range 6–11), using quantitative estimates 17% of the time. Patients recalled significantly fewer harms (median recall 2, interquartile range 0–3, t(38) = 9.3, p < .001). Better recall was associated with discussing potential harms with a nurse after seeing the physician (odds ratio 7.5, 95% confidence interval 1.3–67.0, p = .04.) Clinicians initiated 63% of discussions of harms and benefits while patients and families initiated 69% of discussions about values and preferences (Chi-squared(1) = 37.8, p < .001). 56% of patients reported their clinician asked what mattered to them.ConclusionsRadiation oncology clinics may wish to use interprofessional care and initiate more discussions about what matters to patients to heed Jain’s (2014) reminder that, “a patient isn’t a disease with a body attached but a life into which a disease has intruded.”
Highlights
Shared decision making is associated with improved patient outcomes in radiation oncology
The three core practices within shared decision making are identifying that a decision must be made, communicating the potential benefits and harms of options, and incorporating what matters to the patient relevant to the decision [6, 15, 16]
We conducted this analysis inductively, an existing framework resonated in the data. This framework is taught in our academic medical center as four categories of what matters to patients and should be discussed in clinical consultations: perceptions, inquiétudes, craintes and attentes
Summary
Shared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices–namely, communicating potential harms and benefits and discussing what matters to patients–occur in usual care. The three core practices within shared decision making are identifying that a decision must be made, communicating the potential benefits and harms of options (including doing nothing yet), and incorporating what matters to the patient relevant to the decision [6, 15, 16]. This study aimed to observe real-world communication practices in radiation oncology in an urban. Pilote et al BMC Medical Informatics and Decision Making (2019) 19:84 academic medical center, their effects on patient recall of benefits and harms, and whether and how patients’ values and preferences entered the conversation
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