title: Deciding about (neo-)adjuvant rectal and breast cancer treatment: Missed opportunities for shared decision making.
abstract: BACKGROUND
  The first step in shared decision making (SDM) is creating choice awareness. This is particularly relevant in consultations concerning preference-sensitive treatment decisions, e.g. those addressing (neo-)adjuvant therapy. Awareness can be achieved by explicitly stating, as the 'reason for encounter', that a treatment decision needs to be made. It is unknown whether oncologists express such reason for encounter. This study aims to establish: 1) if 'making a treatment decision' is stated as a reason for the encounter and if not, what other reason for encounter is provided; and 2) whether mentioning that a treatment decision needs to be made is associated with enhanced patient involvement in decision making.
  
  
  METHODS
  Consecutive first consultations with: 1) radiation oncologists and rectal cancer patients; or 2) medical oncologists and breast cancer patients, facing a preference-sensitive treatment decision, were audiotaped. The tapes were transcribed and coded using an instrument developed for the study. Oncologists' involvement of patients in decision making was coded using the OPTION-scale.
  
  
  RESULTS
  Oncologists (N = 33) gave a reason for encounter in 70/100 consultations, usually (N = 52/70, 74%) at the start of the consultation. The reason for encounter stated was 'making a treatment decision' in 3/100 consultations, and 'explaining treatment details' in 44/100 consultations. The option of foregoing adjuvant treatment was not explicitly presented in any consultation. Oncologist' involvement of patients in decision making was below baseline (Md OPTION-score = 10). Given the small number of consultations in which the need to make a treatment decision was stated, we could not investigate the impact thereof on patient involvement.
  
  
  CONCLUSIONS
  This study suggests that oncologists rarely express that a treatment decision needs to be made in consultations concerning preference-sensitive treatment decisions. Therefore, patients might not realize that foregoing (neo-)adjuvant treatment is a viable choice. Oncologists miss a crucial opportunity to facilitate SDM.
authors.affiliation: a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: Kunneman
authors.affiliation: a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Engelhardt
authors.affiliation: a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: F L Laura
authors.initials: FL
authors.lastname: Ten Hove
authors.affiliation: b Department of Radiotherapy , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Corrie A M
authors.initials: CA
authors.lastname: Marijnen
authors.affiliation: c Department of Medical Oncology , Haga Hospital , the Hague , The Netherlands.
authors.forename: Johanneke E A
authors.initials: JE
authors.lastname: Portielje
authors.affiliation: d Department of Medical Psychology , Academic Medical Center , Amsterdam , The Netherlands.
authors.forename: Ellen M A
authors.initials: EM
authors.lastname: Smets
authors.affiliation: d Department of Medical Psychology , Academic Medical Center , Amsterdam , The Netherlands.
authors.forename: Hanneke J C J M Hanneke
authors.initials: HJ
authors.lastname: de Haes
authors.affiliation: a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000523:psychology; D010358:Patient Participation; D057240:Patient Preference; D010817:Physician-Patient Relations; D010820:Physicians; D012004:Rectal Neoplasms / Q000523:psychology / Q000628:therapy*; D012017:Referral and Consultation