Study highlights challenges of shared decision-making in advanced lung cancer care

A new study shows that patients can experience reduced co-determination and insufficient information about their cancer treatment, while doctors face pressure to give treatment they do not consider useful.

Shared decision-making is the norm in the patient's healthcare service but may be difficult to accomplish. A new study in Norway has investigated what needs and challenges patients with advanced lung cancer, their relatives, nurses, and doctors experience when deciding on a treatment plan.

Continuity in the patient-healthcare personnel relationship and familiarity with each other were emphasized as absolutely fundamental when trying to make the best possible decisions."

Margrethe Aase Schaufel, associate professor at the University of Bergen and senior author of the article

Patients do not understand that they can refrain from treatment.

The study participants reported that it was difficult to communicate and understand complicated assessments of what further cancer treatment may entail in terms of benefits and harms.

"Although patients could be satisfied with the follow-up and treatment recommended by the doctor, information was also given about situations where they had not understood that they could refrain from life-prolonging treatment which resulted in a significantly reduced quality of life", Schaufel says.

Doctors feel pressured to give treatment that could be harmful.

Some patients experienced having to fight for more treatment than what the doctor thought was advisable. And doctors reported pressure to give treatment that could be useless and harmful.

"The doctors expressed a need for tools that provide more reliable knowledge about treatment tolerance and effect for the individual patient", says Schaufel.

"We need measures that can ensure enough time to dialogue and communication".

The study concludes that it is difficult to develop a so-called decision aid for advanced lung cancer that will be able to solve the challenges and needs reported by stakeholders, especially when there is great uncertainty related to the effect of several lines of treatment in advanced disease.

"Measures are called for that can ensure continuity in the patient-healthcare professional relationship and enough time for dialogue, communication training for clinicians to increase the patient autonomy, and better scoring tools for treatment tolerance", Schaufel concludes.