scholarly journals How are decisions made in cancer care? A qualitative study using participant observation of current practice

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016360 ◽  
Author(s):  
Pola Hahlweg ◽  
Martin Härter ◽  
Yvonne Nestoriuc ◽  
Isabelle Scholl
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Qualitative Content Analysis ◽  
Participant Observation ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Field Notes ◽  
Made In

ObjectivesShared decision-making has continuously gained importance over the last years. However, few studies have investigated the current state of shared decision-making implementation in routine cancer care. This study aimed to investigate how treatment decisions are made in routine cancer care and to explore barriers and facilitators to shared decision-making using an observational approach (three independent observers). Furthermore, the study aimed to extend the understanding of current decision-making processes beyond the dyadic physician–patient interaction.DesignCross-sectional qualitative study using participant observation with semistructured field notes, which were analysed using qualitative content analysis as described by Hsieh and Shannon.Setting and participantsField notes from participant observations were collected at n=54 outpatient consultations and during two 1-week-long observations at two inpatient wards in different clinics of one comprehensive cancer centre in Germany.ResultsMost of the time, either one physician alone or a group of physicians made the treatment decisions. Patients were seldom actively involved. Patients who were ‘active’ (ie, asked questions, demanded participation, opposed treatment recommendations) facilitated shared decision-making. Time pressure, frequent alternation of responsible physicians and poor coordination of care were the main observed barriers for shared decision-making. We found high variation in decision-making behaviour between different physicians as well as the same physician with different patients.ConclusionMost of the time physicians made the treatment decisions. Shared decision-making was very rarely implemented in current routine cancer care. The entire decision-making process was not observed to follow the principles of shared decision-making. However, some aspects of shared decision-making were occasionally incorporated. Individual as well as organisational factors were found to influence the degree of shared decision-making. If future routine cancer care wishes to follow the principles of shared decision-making, strategies are needed to foster shared decision-making in routine cancer care.

scholarly journals Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018337 ◽  
Author(s):  
Leontine Groen-van de Ven ◽  
Carolien Smits ◽  
Fuusje de Graaff ◽  
Marijke Span ◽  
Jan Eefsting ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Critical Points ◽  
Informal Caregivers ◽  
Case Managers ◽  
Shared Decision ◽  
People With Dementia ◽  
Informed Preferences ◽  
Adapted Process

ObjectiveTo explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories.DesignA qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction.SettingCommunity settings and nursing homes in the Netherlands.Participants19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers).ResultsThe participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare.ConclusionShared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.

Sign in / Sign up

Export Citation Format

Share Document