A Crucial Step in Patient-Centered Radiation Oncology

Conceptually, actively involving patients in decision making about radiotherapy will take 4 key steps.1 These are the scaffolds of any SDM-based approach to radiotherapy:

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  • Identify steps in the treatment decision-making process.
  • Adopt a “dynamic view” of treatment planning that acknowledges that early decision-making steps might be revisited as the interaction with a patient progresses toward a final plan.
  • Find approaches to shared decision making that “lie between the three predominant models” of paternalistic, shared, and informed decision making.
  • Recognize practical applications.

That framework accommodates a wide range of operational definitions for SDM.1,2

Further, the “Informed Medical Decisions Foundation defines 6 steps of shared decision making, but the steps are broadly defined,” Dr Berman and her colleagues noted. These steps are:

  • Invite the patient to participate in decision making.
  • Present options.
  • Inform patients about the goals, risks, and potential benefits of each option.
  • Assist patients in matching options to their personal “goals and concerns” for treatment and their lives.
  • “Facilitate deliberation and decision making” and implementation.

Shared decision making decision aids and coding schemes, such as the Decision Analysis System for Oncology (for SDM with patients with early-stage breast cancer), OPTION, and the Decision Support Analysis Tool, have been proposed and are in development.1,3,4

Such decision aids, while not yet in wide clinical use, can be invaluable in ensuring high-quality SDM approaches to radiation oncology, the authors argued.1 They can be presented as handbooks or video tutorials, or interactive online guides.1

“Clear hallmarks of a DA include a detailed, personalized discussion of treatment options within the context of a patient’s specific demographics, disease-related features, and personal beliefs,” allowing an explicit articulation of the patient’s goals, values, and concerns.1 

Barriers to implementation of decision aids and shared decision making include staffing limitations, implementation’s time demands, reimbursement, and system-level tools and infrastructure. Ultimately, embedding decision aids into patients’ electronic health records (EHRs) will be a crucial step toward routine implementation and clinical utilization. It will require coordination with software vendors, championing of the effort by opinion leaders and departmental decision makers, and either reimbursement incentives or “peer pressure” within the department, Dr Berman and colleagues wrote.1 

Shared decision making can also facilitate patient participation in clinical trials, such as those that have established that stereotactic body radiotherapy (SBRT) is a viable alternative to surgery for patients with stage I non-small cell lung cancer who are ineligible for surgery, with excellent safety and tumor control rates.1  SDM approaches are also improving accrual to studies of SBRT’s value for patients who are candidates for surgery.1