Newcastle Cancer Control Collaborative (New-3C), NSW


How can we improve patient-centred decision making in cancer care?

Patient-centred decision making is a key characteristic of a high quality healthcare system. Clinicians and patients need to work together and incorporate the best available evidence regarding different healthcare options with patients’ goals and concerns. Actively involving patients in decisions regarding their care can increase patients’ knowledge, satisfaction and overall quality of life. A number of interventions have been developed to help patients make difficult healthcare decisions. One such strategy are decision aids. Decision aids provide patients with tailored information regarding their healthcare decisions and help them become more involved in the decision making process. Decision aids have been shown to improve patient outcomes, including increased knowledge and decreased decisional conflict. However, decisions aids are not commonly used in clinical practice.

We undertook a literature review to examine where decision aid research has been directed to and where the focus of future research should lie. Changes in the volume of research on the effectiveness of cancer-related decision aids were examined across three time points and eligible articles were categorised by cancer type and decision type. We then compared the number of studies that assessed the effectiveness of cancer-related decision aids to the number of studies that assessed implementation strategies which aimed to increase the use of decision aids by healthcare providers. Medline, Embase, PsychInfo and Cochrane Database of Systematic Reviews were searched. Eligible papers were those published in any country in 2000, 2007 or 2014. These years were chosen given the release of two influential reports on patient-centred care by the US National Cancer Board and the Institute of Medicine in 1999 and 2001.

Over the three time points assessed, increasing research effort has been directed towards examining the effectiveness of decision aids in improving patient outcomes. The number of studies testing cancer screening or prevention decision aids increased statistically significantly; the number of studies testing cancer treatment decision aids did not. Most studies assessed the effectiveness of decision aids for prostate, breast or colon cancer. This is not surprising as these are among the most common cancer types worldwide. However, there are other cancer types which often include difficult decisions for patients. For example, lung cancer patients might have to trade off slightly higher survival rates with severe treatment side effects. Only two studies assessed the effectiveness of implementation strategies to increase the use of decision aids by healthcare providers.

More research is needed on other cancer populations and other decision types, such as treatment decisions. This data may be useful in designing decision support that suits the needs of different patient populations. The next step must be to translate the evidence of decision aids’ effectiveness into meaningful benefits for patients by implementing decision aids into clinical practice. This will help improve patient-centred decision making in routine cancer care. This review has recently been published in BMC Medical Informatics and Decision Making (Herrmann A, Mansfield E, Hall AE, Sanson-Fisher R, Zdenkowski N. (2016). Wilfully out of sight? A literature review on the effectiveness of cancer-related decision aids and implementation strategies. BMC Medical Informatics and Decision Making, 16(1), 1-9. doi: 10.1186/s12911-016-0273-8).

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