Communication in Shared Decision-Making in Oncology

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Patients often seemed to assume that a physician may not be interested in the patient's values, contrary to reality.
Patients often seemed to assume that a physician may not be interested in the patient's values, contrary to reality.

Medical decisions frequently entail a mutual effort between a patient and care provider, though the best approach is not always obvious. A study recently published in The Oncologist outlines barriers to communication.

The researchers followed communications between oncologists (n=5) and patients with gastrointestinal tumors (n=18) for whom an optional adjuvant chemotherapy was available, by observing physician-patient consultations and then following up with each participant.

Patients in consultations tended to limit communication to medical details and requests for medical insight.

Patients often seemed to assume that a physician may not be interested in the patient's values or that the physician is there to tend only to physical concerns. This may be particularly evident with oncology, a complex area of medicine around which patients may feel incapable of fully understanding the best way forward, relying heavily on an oncologist's expertise.

Physicians, contrarily, tended to desire more insight into patients' values and how they arrive at decisions, with one physician stating this would aid in knowing how to tailor information to a patient.

One approach oncologists used in this study to understand patient values was biographical, encouraging the patient to describe his/her history and then making assumptions about values based on what is communicated. The other approach, termed metacommunicative, involved the oncologist speaking directly about the decision-making process and expressing his or her own intentions, such as a lack of desire to frighten the patient or talk a patient into a particular treatment.

The researchers noted the biographical approach may be misleading due to the formation of assumptions, while the metacommunicative approach may overwhelm a patient. Therefore, they recommend a flexible approach, adaptive to a patient's communication style, and/or initial evaluation of patient preference.

Reference

Haltaufderheide J, Wäscher S, Bertlich B, Vollmann J, Reinacher-Schick A, Schildmann J. “I need to know what makes somebody tick …”: Challenges and strategies of implementing shared decision-making in individualized oncology [published online September 6, 2018]. Oncologist. doi: 10.1634/theoncologist.2017-0615.

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