title: Perspectives of Medical Specialists on Sharing Decisions in Cancer Care: A Qualitative Study Concerning Chemotherapy Decisions With Patients With Recurrent Glioblastoma.
abstract: BACKGROUND
  In cancer care, difficult decisions concerning advanced treatment need to be made, weighing possible life prolongation against harmful side effects. Treatment is frequently started, showing the need to explore how decisions are made. Little is known about the perspectives of physicians on sharing decision making with patients. This qualitative study aimed to describe the perspectives of medical specialists on the decision-making process with patients with glioblastoma concerning starting new treatment.
  
  
  METHODS
  Qualitative interviews were held with medical specialists. One focus group was organized with medical professionals. Their opinions about elements of shared decision making and the applicability in the context of patients with glioblastoma were assessed. The topic list for the focus group was based on the analysis of the interviews. Qualitative analysis of the transcripts was performed by three researchers independently.
  
  
  RESULTS
  Medical specialists considered shared decision making to be important; however, they did not adhere to its elements. Stopping treatment was not considered equal to continuing treatment. Exploration of the patients' wishes was done implicitly, and shared responsibility for the decision was not highly recognized. The main barriers to shared decision making were preferences of both patients and specialists for starting or continuing treatment and assumptions of physicians about knowing what patients want.
  
  
  CONCLUSIONS
  Medical specialists recognized the importance of patient involvement but experienced difficulty in sharing decision making in practice. Elements of shared decision making are partly followed but do not guide decision making. To improve cancer care, education of medical specialists and adjustment to the elements are needed to involve patients.
authors.affiliation: Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands eol@vumc.nl.
authors.forename: Janine C
authors.initials: JC
authors.lastname: De Snoo-Trimp
authors.affiliation: Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Brom
authors.affiliation: Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands.
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.affiliation: Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.affiliation: Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands.
authors.forename: Guy A M
authors.initials: GA
authors.lastname: Widdershoven
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D017144:Focus Groups; D005909:Glioblastoma / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007407:Interviews as Topic; D008020:Life Support Care; D008137:Longitudinal Studies; D009364:Neoplasm Recurrence, Local; D010817:Physician-Patient Relations; D010820:Physicians; D036301:Qualitative Research
keywords: End-of-life care; Glioblastoma; Medical ethics; Medical specialists; Qualitative research; Shared decision making