Factors which motivate cancer doctors to involve their patients in reaching treatment decisions.
OBJECTIVE
Cancer patients increasingly expect to be involved in treatment decision-making. We investigated factors that motivate cancer doctors to involve their patients in treatment decisions.


METHODS
We conducted 22 telephone interviews with doctors treating breast, colorectal, gynaecological, haematological or prostate/urological cancer. Interviews probed doctors for attitudes to shared decision-making (SDM), views of when patient involvement is appropriate and what motivated them to encourage involvement. Interviews were audio-recorded. Themes were identified using framework analysis.


RESULTS
Cancer doctors described disease, patient, doctor and societal influences on their support for patient involvement in treatment decisions. Treatment recommendations were described as 'clear-cut' or 'grey'. When treatment options were clear-cut, the impact of treatment on patients' quality of life and self-image and the influence of consumer groups motivated doctors' support of patient involvement.


CONCLUSIONS
Australian cancer doctors express differing support of patient involvement in decision-making dependent on context, impact and effect that involvement may have. Doctors described meeting patient involvement preferences as a challenge, and needing to identify different characteristics, anxiety levels and levels of understanding to guide them to involve patients in decisions.


CONCLUSIONS
Models of shared decision-making may warrant refinement to better guide doctors to elicit and discuss information and involvement preferences.
School of Public Health and Community Medicine, University of New South Wales, NSW, Australia. heather.shepherd@sydney.edu.au
Heather L
HL
Shepherd
Phyllis N
PN
Butow
Martin H N
MH
Tattersall
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009042:Motivation; D009369:Neoplasms / Q000628:therapy*; D010358:Patient Participation; D057240:Patient Preference; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D013689:Telephone