Factors which motivate cancer doctors to involve their patients in reaching treatment decisions.

Abstract

OBJECTIVE: Cancer patients increasingly expect to be involved in treatment decision-making. We investigated factors that motivate cancer doctors to involve their patients in treatment decisions. METHODS: We conducted 22 telephone interviews with doctors treating breast, colorectal, gynaecological, haematological or prostate/urological cancer. Interviews probed doctors for attitudes to shared decision-making (SDM), views of when patient involvement is appropriate and what motivated them to encourage involvement. Interviews were audio-recorded. Themes were identified using framework analysis. RESULTS: Cancer doctors described disease, patient, doctor and societal influences on their support for patient involvement in treatment decisions. Treatment recommendations were described as 'clear-cut' or 'grey'. When treatment options were clear-cut, the impact of treatment on patients' quality of life and self-image and the influence of consumer groups motivated doctors' support of patient involvement. CONCLUSION: Australian cancer doctors express differing support of patient involvement in decision-making dependent on context, impact and effect that involvement may have. Doctors described meeting patient involvement preferences as a challenge, and needing to identify different characteristics, anxiety levels and levels of understanding to guide them to involve patients in decisions. PRACTICE IMPLICATIONS: Models of shared decision-making may warrant refinement to better guide doctors to elicit and discuss information and involvement preferences.