The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case study

Abstract

Background: Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient’s context into decision-making. To improve this, we conducted a quality improvement project, CONtext. CONtext attempts to accomplish this by: (1) Integrating the patient’s context into shared decision-making during consultation with the medical oncologist; (2) Actively involving the GP and case manager (a specialized oncology nurse), who often have knowledge about the patient’s context, and; (3) Giving the person with advanced cancer a time-out period of up to 2 weeks to consider and discuss treatment options with others, including close family and friends. Aim: To explore how persons with advanced cancer and their involved professionals experienced shared decision-making after the introduction of CONtext. Design: A qualitative embedded multiple-case study using in-depth interviews analysed with inductive content analysis. Participants: A purposive sample of 14 cases, each case consisting of a patient with advanced cancer and ideally their medical oncologist, case manager, and GP. Results: Four themes were identified: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist’s treatment recommendation is central (2), fuelled by the patients’ experience of not having a choice (3), and integrating the patient’s context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase. Conclusions: The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making. This undermines integrating individual context into decision-making, a critical aspect of the palliative care continuum.