title: A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study.
abstract: BACKGROUND
  Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with a stage I non-small cell lung cancer (NSCLC). Consequently, there is growing interest in studying the role of patients in treatment decision making. We studied how patients with stage I NSCLC perceived shared decision making (SDM) in general, and how they viewed different aspects of SDM.
  
  
  METHODS
  A sequential mixed methods design was used, consisting of qualitative interviews (N=11), as well as a survey study (N=76) focusing on different SDM-related aspects. Participants were interviewed to understand their own experience with treatment decision making. In the survey study, patients rated the importance of 20 aspects of shared decision making that were identified during interviews. Descriptive analysis and explorative factor analysis were performed.
  
  
  RESULTS
  We assessed six qualitative themes covering SDM aspects that were determined by patients to be important. The survey identified four SDM-related factors with sufficient internal consistency, namely (1) 'guidance by clinician' (α=.741), (2) 'conduct of clinician' (α=.774); (3) 'preparation for treatment decision making' (α=.864); and (4) 'active role of patient in treatment decision making' (α=.782). Of these, clinician guidance was rated as most important by patients (M=3.61; SD=.44). Only 28.9% of patients in the survey study reported that both treatment options were discussed with them.
  
  
  CONCLUSIONS
  Patients with a stage I NSCLC found clinician guidance to be important when making treatment decisions. Nevertheless, the majority of patients reported not being offered both treatment options, which might have influenced this finding.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. w.hopmans@vumc.nl.|Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. w.hopmans@vumc.nl.
authors.forename: Wendy
authors.initials: W
authors.lastname: Hopmans
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. o.damman@vumc.nl.
authors.forename: Olga C
authors.initials: OC
authors.lastname: Damman
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. s.senan@vumc.nl.
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
authors.affiliation: Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. k.hartemink@nki.nl.
authors.forename: Koen J
authors.initials: KJ
authors.lastname: Hartemink
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. e.smit@nki.nl.|Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. e.smit@nki.nl.
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. drm.timmermans@vumc.nl.
authors.forename: Danielle R M
authors.initials: DR
authors.lastname: Timmermans
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010358:Patient Participation; D010817:Physician-Patient Relations; D011013:Pneumonectomy; D011446:Prospective Studies; D036301:Qualitative Research; D016634:Radiosurgery