How can shared decision making support cancer care?

Upon receiving a cancer diagnosis, patients may have difficulty processing information about treatment options, particularly given the wide range of treatments available today. Because each treatment has its own characteristics, benefits, and drawbacks, patients need immediate access to detailed and unbiased information to help them determine the best treatment course. Presenting patients with a shared decision-making tool can help. Ideally, such tools would present information about all available treatments and include questions about a person’s health goals, lifestyle, and personal priorities to help them choose a course of treatment that works best for them.

Isn’t it the doctor’s job to recommend a treatment?

Yes. But without a shared decision-making process, the patient’s values may be overlooked. Shared decision making ensures that the treatment course selected reflects the patient’s priorities.

What are the benefits of shared decision making in cancer care?

Shared decision making helps to ensure that patients clearly understand costs and benefits associated with every available treatment option, allowing them to choose treatments that reflect their goals or preferences. Evidence suggests that patient-driven treatment choices can result in reduced patient anxiety and depression, improved treatment adherence, and better outcomes for patients with cancer. These benefits may also translate into more effective resource use at the health system level if outcomes improve and future hospitalizations are avoided or reduced.

When is shared decision making most appropriate?

Experts say that shared decision making is most beneficial when more than 1 viable screening or treatment option exists, no path presents a clear advantage over the others, or the benefits and risks associated with each treatment could affect the patient differently. Given the variety of treatments available for many cancers, shared decision making may help patients weigh the costs and benefits of the available treatment options.

What kinds of factors drive patient treatment decisions?

When choosing a course of treatment, patients consider factors beyond the ability to defeat cancer and extend life. Avalere research indicates that patients are also concerned with quality of life and financial cost, as well as relative discomfort and restrictions or side effects associated with different treatments. They appreciate receiving testimonials from other patients reporting how they have responded to treatment and the types of side effects experienced (e.g., the level of exhaustion resulting from treatment). This information helps give patients a sense of what to expect.

What has Avalere learned about the factors that patients value?

The same study showed that individuals facing the same diagnosis may have different priorities and expectations. The study involved patients with triple-negative breast cancer—a highly aggressive cancer type. The patients queried identified a range of factors influencing their decisions:

• 71% of participants said they considered longevity and survivability when making their initial treatment decisions
• 47% prioritized quality of life, which included overall health impacts and the ability to continue caring for children, spending time with family, and continuing to work
• 22% said limiting duration of treatment was a factor in driving treatment choices
• 18% mentioned their provider’s medical opinion and trust in their care team as central to their treatment decision making

These findings show that, although many patients care about extending life, other objectives, including those related to quality of life, may also affect patient decisions.

What is needed to help patients participate in decision making with their doctors?

Just as physicians can be more cognizant of a patient’s realities, patients can begin to take a more proactive role in their own care. For some, this comes easy. For others, continuing to defer to the physician’s opinion is the most comfortable approach. A shared decision-making tool may close gaps in knowledge, empower patients to make decisions in their care, and unlock the related optimal treatment outcomes.

How Avalere Can Help

Avalere has extensive experience developing shared decision-making aids for oncology care. To learn more about how we partner with stakeholders interested in creating these essential resources (e.g., providers, advocacy groups, life science companies), connect with us.