This study aims to: (1) to examine how clinicians in the United Kingdom make decisions related to cancer, and (2) to identify need for support for such decisions. Involvement of patients in medical decision making process is becoming increasingly important within the current healthcare system. The paternalistic model (in which decisions are made for patients) seems to have been replaced by the informed model (in which patients make decisions on their own based on information given by the health-care providers) and shared decision-making model (in which clinicians and patients collaborate with each other to make decisions). Shared decision-making model (SDM) is regarded as the ideal form of decision making in modern health care. It allows patients freedom of choice, while at the same time provides necessary support in the decision making process.
METHODS AND PROCEDURES
We conducted an interview study (August 2009) involving 20 clinicians (10 registrar surgeons and 10 consultants) from various hospitals in London who were experienced in cancer management. The clinicians gave their opinion about: (1) the decisions they considered difficult to make by themselves and by their patients, (2) whether and to what extent they influenced patients’ decisions and (3) how they assessed the quality of the decisions.
We recorded and transcribed the interviews and analyzed the scripts using key-word analysis and cognitive-mapping.
A majority of the clinicians considered the decision of whether or not to operate difficult both for them and for their patients, due to certain diagnostic limitations in staging tumours, uncertainties regarding the outcomes, compounded by the difficulties for patients to imagine a different life style and predict their future requirements. They also believed some patients find it difficult to decide whether or not to trust the clinicians.
On the other hand, five registrar surgeons believed they did not influence patients’ decision making, stating their role was to provide information for patients and that it was impossible for them to gauge how patients could have made the decisions. Two senior clinicians acknowledged that patients did not perceive they had a decision to make at all. Decision qualities were commonly assessed based on peer consensus, less so on patients’ feedbacks.
As a pilot, this study is limited in the representativeness of the sample. Future studies should explore the extent to which these findings hold true for a larger population of clinicians with different specialities and working at different hospitals. However, our study demonstrated a clear need to raise awareness among clinicians in terms of making decisions with patients rather than for patients. Most clinicians understand the importance of patients’ preferences, though having difficulties in making use of them. In other words, SDM is promising but is still competing with the traditional paternalistic model. It is important that decision aids for patients should promote SDM as one of its aims, or at least, be conductive to the interactions between clinicians and patients.
Program Number: P199