The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case study.

Autor:	Ermers DJ; Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.; Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands., van Geel MJ; Consultancy Group Process Improvement and Implementation, Radboudumc, Nijmegen, The Netherlands., Engels Y; Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands., Kellenaers D; Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands., Schuurmans AS; Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands., Ploos van Amstel FK; Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands., van Herpen CM; Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands., Schoon Y; Department of Geriatrics, Radboudumc, Nijmegen, The Netherlands., Schers HJ; Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands., Vissers KC; Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands., Kuip EJ; Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.; Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands., Perry M; Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
Jazyk:	angličtina
Zdroj:	Palliative medicine [Palliat Med] 2024 Dec; Vol. 38 (10), pp. 1156-1168. Date of Electronic Publication: 2024 Sep 27.
DOI:	10.1177/02692163241281145
Abstrakt:	Background: Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. To improve this, we conducted a quality improvement project, CONtext. CONtext attempts to accomplish this by: (1) Integrating the patient's context into shared decision-making during consultation with the medical oncologist; (2) Actively involving the GP and case manager (a specialized oncology nurse), who often have knowledge about the patient's context, and; (3) Giving the person with advanced cancer a time-out period of up to 2 weeks to consider and discuss treatment options with others, including close family and friends. Aim: To explore how persons with advanced cancer and their involved professionals experienced shared decision-making after the introduction of CONtext . Design: A qualitative embedded multiple-case study using in-depth interviews analysed with inductive content analysis. Participants: A purposive sample of 14 cases, each case consisting of a patient with advanced cancer and ideally their medical oncologist, case manager, and GP. Results: Four themes were identified: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase. Conclusions: The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making. This undermines integrating individual context into decision-making, a critical aspect of the palliative care continuum. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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