Understanding treatment decision making: contexts, commonalities, complexities, and challenges.
BACKGROUND
The diagnosis of cancer sets off a cascade of complex decisions at a time when patients feel vulnerable and distressed. Although clinical decisions used to follow one standard, many guidelines now outline several options and include explicit recognition of the need to incorporate patients' preferences to determine the most appropriate treatment.


OBJECTIVE
The purpose of this article is to provide a brief overview of empirical studies about cancer patients' treatment-related decision making, to highlight the areas of congruence and divergence in that empirical literature, and then to generate a framework that points to future interventions and research.


METHODS
Through a group discussion with a range of experts in the field, we generated a framework for the critical treatment decisions and key issues within those decisions. Then, we reviewed the literature describing the experiences of cancer patients and evaluating interventions designed to improve the quality of treatment decisions.


RESULTS
We identified four major differences that influence decision making across cancers and across individuals with the same diagnosis. We also identified four common themes across situations and people. There is considerable evidence that decision aids can improve the quality of decisions across a range of diseases, although the data for cancer treatment decision making are limited. Other interventions such as navigation-skill training are promising but have little evidence of benefit for cancer decisions.


CONCLUSIONS
There are many opportunities for behavioral research to extend and contribute to the understanding and improvement of cancer treatment decision making. Some key areas in need of research include developing taxonomies of disease and patient characteristics and increasing understanding of the lived experiences of cancer survivors, of the influence of time and timing, of the relationship of information and preferences, and of participation in randomized clinical trials.
Blank
Thomas
T
Human Development and Family Studies, University of Connecticut, Storrs, CT 06269-2058, USA. Thomas.blank@uconn.edu
Graves
Kristi
K
Sepucha
Karen
K
Llewellyn-Thomas
Hilary
H
D032882:Comprehension; D003657:Decision Making; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010358:Patient Participation / Q000523:psychology; D017410:Practice Guidelines as Topic; D012106:Research