Are patient goals discussed during treatment decision-making in patients with head and neck cancer? A qualitative content analysis of consultations.

Abstract

Decision-making with patients with head and neck cancer is complex due to their vulnerability, even at a young age, and the intensity of the treatment. Discussing patient goals, values and preferences is crucial for tailoring treatment and patient-centered care, especially given the high levels of decisional conflict and regret among this patient group. This study aimed to explore whether, how, and which patient goals were discussed during treatment decision-making consultations and how surgeons responded to these goals. This study is a secondary analysis of a cross-sectional study. A qualitative content analysis was performed on transcripts from audio recordings of treatment decision-making consultations between patients and surgeons at the head and neck cancer outpatient clinic from two tertiary centers in the Netherlands. Goals or goal-related cues were identified utilizing the three-goal model by Vermunt and the health outcomes of the Outcome Prioritization Tool. Sixty-six transcripts were analyzed, corresponding to 66 patients and nine head and neck surgeons. In 11 consultations, no goals were mentioned. In the remaining 55 consultations, goals were most often mentioned by patients or their relatives, usually implicit and often due to concerns or fears. In one consultation goals were elicited by the surgeon. The most frequently mentioned goals were related to life extension, functional outcomes, or symptom-specific issues. Surgeons typically responded to goals with 'medical-technical' explanations about treatment or disease. Patient goals were not routinely discussed during decision-making with head and neck cancer patients. When mentioned, the initiative often came from the patient or their relatives. Surgeons regularly responded with a medical technical explanation, and the underlying considerations or concerns of the patient were often not further explored. This can be considered a missed opportunity to discuss patient goals and for personalized care.