Clinical issues in shared decision-making applied to breast cancer.
OBJECTIVE
To assess (1) the clinical issues addressed during the medical encounter; (2) the feasibility of the process of shared decision-making in clinical practice and (3) patients' desires concerning the question of 'who should take the decision in breast cancer treatments?'


METHODS
Qualitative pilot study based on clinical encounters using decision boards and information booklets.


METHODS
Centre Léon Bérard, a comprehensive cancer centre in the Rhône-Alpes region of France.


METHODS
One breast cancer surgeon and 22 breast cancer patients.


METHODS
Analysis of patients' reactions to a shared decision-making process concerning surgery and chemotherapy, and analysis of its practical feasibility (i.e. duration of the consultations).


RESULTS
(1) Twenty-one patients participated in the decision regarding surgery; all chose conservative treatment; 15 patients had their own say about chemotherapy (nine chose no chemotherapy, six chose chemotherapy). (2) Participating in treatment choice generated anxiety for a majority of patients. Some were dissatisfied because they had to make a choice and consequently to give up the other option. Finally, some were uncertain about making the right choice. Nevertheless, most were satisfied with the information given and the possibility of participating to the treatment decision-making process. (3) The total duration of the entire process of shared decision-making is consistent with the time spent with patients with such a severe disease.


CONCLUSIONS
Most of the patients expressed their satisfaction regarding the possibility to participate in treatment decision-making, knowing that offering treatment choice is very unusual in France. From this pilot study it appears that shared decision-making is feasible in clinical practice. Nevertheless, a quantitative study based on a large sample of patients is necessary to: (1) confirm this hypothesis, (2) ensure that patients are willing to participate in their treatment decision-making, and (3) measure the potential benefits related to this participation.
Moumjid
Nora
N
GRESAC UMR 5823 CNRS, Centre Léon Bérard, Lyon, France.
Carrère
Marie-Odile
MO
Charavel
Marie
M
Brémond
Alain
A
D001007:Anxiety; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003657:Decision Making; D005260:Female; D005602:France; D006302:Health Services Research; D006801:Humans; D010358:Patient Participation / Q000523:psychology; D010817:Physician-Patient Relations; D010865:Pilot Projects