title: Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery.
abstract: BACKGROUND
  Decisions leading up to surgery are fraught with uncertainty owing to trade-offs between treatment effectiveness and quality of life. Past studies on shared decision-making (SDM) have focused on the physician-patient encounter, with little emphasis on familial and cultural factors. The literature is scarce in surgical oncology, with few studies using qualitative interviews. Our objective was to explore the complexities of SDM within the setting of colorectal cancer (CRC) surgery.
  
  
  METHODS
  An interdisciplinary team developed a semistructured questionnaire. Telephone interviews were conducted with CRC patients in the practice of 1 surgical oncologist. Data saturation was achieved and a descriptive thematic analysis was performed.
  
  
  RESULTS
  We interviewed 20 patients before achieving data saturation. Three major themes emerged. First, family was considered as a crucial adjunct to the patient-provider dyad. Second, patients identified several facilitators to SDM, including a robust social support system and a competent surgical team. Although language was a perceived barrier, there was no difference in level of involvement in care between patients who spoke English fluently and those who did not. Finally, patients perceived a lack of choice and control in decision-making, thus challenging the very notion of SDM.
  
  
  CONCLUSIONS
  Surgeons must learn to appreciate the role of family as a vital addition to the patient-provider dyad. Family engagement is crucial for CRC patients, particularly those undergoing surgical resection of late-stage disease. Surgeons must be aware of the uniqueness of decision-making in this context to empower patients and families.
authors.affiliation: From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam).
authors.forename: Dhruvin H
authors.initials: DH
authors.lastname: Hirpara
authors.affiliation: From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam).
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Cleghorn
authors.affiliation: From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam).
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.affiliation: From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam).
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D011369:Professional-Patient Relations; D036301:Qualitative Research