title: Doing the right thing: systems support for decision quality in cancer care.
abstract: BACKGROUND
  There is considerable evidence of problems with the quality of cancer care. Wide variation in rates of interventions suggests that cancer care decisions may not reflect the preferences of informed patients.
  
  
  OBJECTIVE
  To present a framework for systems support for improving the quality of decisions in cancer.
  
  
  METHODS
  We outlined the types of decisions faced by cancer patients and categorized them based on the level of evidence available about effectiveness of choices and the amount of variation in patients' preferences for the key outcomes. Then we describe appropriate strategies to systematically improve the quality of decision making for each category.
  
  
  RESULTS
  The types of decisions faced by cancer patients and providers are varied. The appropriate strategy to drive improvements differs for different decisions. For complex, preference-sensitive decisions, improvements in decision quality require increasing patients' knowledge and the match between patients' preferences and treatments.
  
  
  CONCLUSIONS
  Decision making in cancer care is complex. Neither patients nor providers can make treatment decisions alone. System support is needed to improve the quality of decisions.
authors.affiliation: General Medicine Division, Health Decision Research Unit, Massachusetts General Hospital, Harvard Medical School Boston, MA 02114, USA. ksepucha@partners.org
authors.forename: Karen
authors.initials: K
authors.lastname: Sepucha
authors.forename: Elissa
authors.initials: E
authors.lastname: Ozanne
authors.forename: Albert G
authors.initials: AG
authors.lastname: Mulley
mesh_terms: D002755:Choice Behavior; D003657:Decision Making; D003695:Delivery of Health Care / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000517:prevention & control / Q000628:therapy*; D010358:Patient Participation; D011786:Quality Control; D011787:Quality of Health Care; D012944:Social Support