SHARED DECISION MAKING IN ONCOLOGY AND PALLIATIVE CARE
Keywords:shared decision making, oncology, palliative care, person-centered medicine, treatment planning, preference-based medicine, evidence-based medicine, choices/options/decision talk prospect theory
AbstractBackground: Cancer raises many questions for people afflicted by it. Do I want to have genetic testing? Will I comply with screening recommendations? If I am diagnosed with it, where will I have treatment? What treatment modalities will I have? Will I go on a clinical trial? Am I willing to bankrupt my family in the process of pursuing treatment? Will I write an advance care plan? Will I accept hospice if I have run out of available treatment options? Most of these questions have more than one correct answer, and the evidence for the superiority of one option over another is either not available or does not allow differentiation. Often the best choice between two or more valid approaches depends on how individuals value their respective risks and benefits; “preference-based medicine” may be more important than “evidence-based medicine.” There are various models for eliciting preferences, but applying them can raise a number of challenges.Objectives: To present the concepts, the value, the strategies, the quandaries, and the potential pitfalls of Shared Decision Making in Oncology and Palliative Care.Method: Narrative review.Results: Some challenges to practicing preference-based medicine in oncology and palliative care include: some patients don’t want to participate in shared decision making (SDM); the whole situation needs to be addressed, not just part of it; but are some topics out of bounds? Cognitive biases apply as much in SDM as any other human decision making, affecting the choice; how numerically equivalent data are framed can also affect the outcome; conducting SDM is also important at the end of life.Conclusions: By being aware of the potential pitfalls with SDM, clinicians are more able to facilitate the discussion so that the patients’ choices truly reflect their informed preferences, at a time when stakes and emotions are high.
Ostermann J, Brown DS, van Til JA, Bansback N, Legare F, Marshall DA, Bewtra M. 2019. Support Tools for Preference-Sensitive Decisions in Healthcare: Where Are We? Where Do We Go? How Do We Get There? Patient 12(5): 439–443.
Quill TE, Holloway RG. 2012. Evidence, Preferences, Recommendations: Finding the Right Balance in Patient Care. New England Journal of Medicine 366 (18): 1653–1655.
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, Tomson D, Dodd C, Rollnick S, Edwards A, Barry M. 2012. Shared Decision Making: A Model for Clinical Practice. Journal of General Internal Medicine 27 (10): 1361–1367.
Kluger J, Park A. 2013. The Angelina Effect. Time Magazine. May 27, 2013.
Bruera E, Sweeney C, Calder K, Palmer L, Benisch-Tolley S. 2001. Patient Preferences versus Physician Perceptions of Treatment Decisions in Cancer Care. Journal of Clinical Oncology 19 (11): 2883–2885.
Verma AA, Razak F, Detsky AS. 2014. Understanding Choice: Why Physicians Should Learn Prospect Theory. Journal of the American Medical Association 311 (6): 571–572.
Christakis NA, Iwashyna TJ. 1998. Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists. Archives of Internal Medicine 158 (21): 2389–2395.
Shih YT, Chien CR. 2017. A Review of Cost Communication in Oncology: Patient Attitude, Provider Acceptance, and Outcome Assessment. Cancer 123 (6): 928–939.
McNeil BJ, Pauker SG, Sox HC Jr., Tversky A. 1982. On the Elicitation of Preferences for Alternative Therapies. New England Journal of Medicine 306 (21): 1259–1262.
Glare P, Fridman I, Ashton-James CE. 2018. Choose Your Words Wisely: The Impact of Message Framing on Patients’ Responses to Treatment Advice. International Review of Neurobiology 139: 159–190.
Higgins ET. 1997. Beyond Pleasure and Pain. American Psychologist 52 (12): 1280–1300.
Avnet T, Higgins ET. 2006. How Regulatory Fit Affects Value in Consumer Choices and Opinions. Journal of Marketing Research 18 (February): 1–10.
Fridman I, Epstein AS, Higgins ET. 2015. Appropriate Use of Psychology in Patient-Physician Communication: Influencing Wisely. JAMA Oncology 1 (6): 725–726.
Fridman I, Glare PA, Stabler SM, Epstein AS, Wiesenthal A, Leblanc TW, Tory Higgins E. 2018. Information Framing Reduces Initial Negative Attitudes in Cancer Patients’ Decisions about Hospice Care. Journal of Pain and Symptom Management 55 (6): 1540–1545.
Quill TE, Arnold R, Back AL. 2009. Discussing Treatment Preferences with Patients Who Want “Everything.” Annals of Internal Medicine 151 (5): 345–349.
Lickiss JN. 2001. Approaching Cancer Pain Relief. European Journal of Pain 5 (Suppl A): 5–14.