Cancer progression and shared decision-making: Crossed.

Abstract

When cancer progresses, changes of treatment are proposed and discussed with patients and their family caregivers (P&Cs). However, there has been insufficient research on these consultations. The objective of this study was to explore how decision-making in cancer progression consultations relates to shared decision-making (SDM) from the perspective of healthcare professionals (HCPS) and P&Cs. A qualitative study was conducted based on 35 semi-structured interviews with HCPs (n = 20) and P&Cs (n = 10 patients and n = 5 family caregivers). Five themes emerged: (1) overview of the decision-making process; (2) a key consultation: discussing progression and treatment options; (3) the central role of the relationship between healthcare professional, patient, and family caregiver; (4) the perception of choice in cancer progression consultations; and (5) participants' perceptions of the elements needed for decision-making. The findings revealed an imbalance in decision-making roles, with physicians primarily making treatment decisions in interdisciplinary meetings, before presenting them to P&Cs in consultation. While cancer progression consultations meet the conditions for SDM, adjustments are needed to enhance the involvement of P&Cs, who often feel passive. Strengthening communication strategies and more actively integrating P&Cs could foster a more balanced, patient-centered approach. Strengthening team cohesion and optimizing interdisciplinary collaboration, systematically involving nurses, and expanding SDM training to include HCPs can foster patient-centered care, enhance communication, and improve decision-making efficiency. An approach that actively integrates patients' values and caregivers' experiential knowledge, combined with a discussion of treatment options, can improve participation without prolonging consultation time.