title: Navigating healthcare: a qualitative study exploring prostate cancer patients' and doctors' experience of consultations using a decision-support intervention.
abstract: BACKGROUND
  Men with prostate cancer face preference-sensitive decisions when choosing among treatments with similar survival outcomes but different procedures, risks and potential complications. A decision-support intervention, 'Decision Navigation' assists men with prostate cancer to prepare a question list (consultation plan) for their doctors and provides them with a consultation summary and audio recording. A randomised controlled trial of Decision Navigation showed advantages over usual care on quantitative measures including confidence in decision-making and regret.
  
  
  OBJECTIVE
  The aim of this study was to gain a qualitative understanding of patient's and doctor's perspectives on Decision Navigation.
  
  
  METHODS
  Six patients who received Decision Navigation were purposively selected for interview out of 62 randomised controlled trial participants. All four doctors who consulted Navigated patients were interviewed. Interview data was analysed using framework analysis.
  
  
  RESULTS
  Patients reported that planning for the consultation helped them to frame their questions, enabling them to participate in consultations and take responsibility for making decisions. They reported feeling more confident in the decisions made, having a written report of the key information and an audio recording. Patients considered routine information relating to side effects was inadequate. Doctors reported that consultation plans made them aware of patients' concerns and ensured comprehensive responses to questions posed. Doctors also endorsed implementing Decision Navigation as part of routine care.
  
  
  CONCLUSIONS
  Results suggest that Decision Navigation facilitated patients' involvement in treatment decision-making. Prostate patients engaging in preference-sensitive decision-making welcomed this approach to personalised tailored support.
authors.affiliation: Clinical Psychology Office, Department of Clinical Oncology, Western General Hospital, Edinburgh, UK.
authors.forename: B
authors.initials: B
authors.lastname: Hacking
authors.forename: S E
authors.initials: SE
authors.lastname: Scott
authors.forename: L M
authors.initials: LM
authors.lastname: Wallace
authors.forename: S C
authors.initials: SC
authors.lastname: Shepherd
authors.forename: J
authors.initials: J
authors.lastname: Belkora
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D010817:Physician-Patient Relations; D011471:Prostatic Neoplasms / Q000523:psychology / Q000628:therapy*; D036301:Qualitative Research; D012017:Referral and Consultation
keywords: cancer; consultations; decisions, support; prostate