title: Shared Decision-Making in Oncology - A Qualitative Analysis of Healthcare Providers' Views on Current Practice.
abstract: BACKGROUND
  Despite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. In order to overcome this challenge, it is important to understand healthcare providers' views regarding SDM and to take their perspectives and opinions into account in the development of an implementation program. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice.
  
  
  METHODS
  A qualitative study was conducted using focus groups and individual interviews with different healthcare providers at the University Cancer Center Hamburg, Germany. Focus groups and interviews were audio-recorded, transcribed and analyzed using conventional content analysis and descriptive statistics.
  
  
  RESULTS
  N = 4 focus groups with a total of N = 25 participants and N = 17 individual interviews were conducted. Attitudes regarding SDM varied greatly between the different participants, especially concerning the definition of SDM, the attitude towards the degree of patient involvement in decision-making and assumptions about when SDM should take place. Experiences on how treatment decisions are currently made varied. Negative experiences included time and structural constraints, and a lack of (multidisciplinary) communication. Positive experiences comprised informed patients, involvement of relatives and a good physician-patient relationship.
  
  
  CONCLUSIONS
  The results show that German healthcare providers in oncology have a range of attitudes that currently function as barriers towards the implementation of SDM. Also, their experiences on how decision-making is currently done reveal difficulties in actively involving patients in decision-making processes. It will be crucial to take these attitudes and experiences seriously and to subsequently disentangle existing misconceptions in future implementation programs.
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Frerichs
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Pola
authors.initials: P
authors.lastname: Hahlweg
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Evamaria
authors.initials: E
authors.lastname: Müller
authors.affiliation: Department Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Adis
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Scholl
mesh_terms: D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D005858:Germany; D006282:Health Personnel; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D036301:Qualitative Research