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283 The role of time in involving cancer patients in treatment decision making: a qualitative study
  1. AE (Lisa) Vlug,
  2. Thomas H Wieringa,
  3. Anke J Woudstra,
  4. Arwen H Pieterse
  1. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands

Abstract

Introduction Cancer patients often face preference-sensitive treatment decisions, for which shared decision making (SDM) is appropriate.1 Time is seen as a resource to SDM.2Patients need time to consider their treatment options, and become involved in treatment decision making.3 Yet, patients (and physicians) often experience too little time, making time both key and a constraint to patient involvement.4 5 This study aims to explore how and when time is a resource, most constrained, and how these time constraints could be resolved.

Methods Individual patient and physician interviews were held. Patients from two cancer populations (i.e., colon cancer and acute myeloid leukemia) and sooner and longer since the treatment decision had been made, were included. These two diagnoses were chosen because patients face a choice between two medically reasonable treatment options, the amount of time available for making the decision markedly differs between the two, and the role of time may be perceived differently between solid and non-solid tumors. Interviews were recorded and transcribed verbatim. Open, axial and selective inductive coding was then applied.

Results 22 physicians and 16 patients participated. Themes emerging relate to time (e.g., how time may be used, variation in individual patient perceptions of sufficient/insufficient time), to determinants (e.g., complexity of time, patient choice awareness), and to suggested strategies to optimize use of time. The analysis is ongoing and will be soon completed.

Discussion Time is reported to be key in helping patients to become active participants in decision making. Participants report time constraints both during and outside of consultations. They further suggest time for decision making can be created even when it is medically constrained.

Conclusion A better understanding of the role and use of time to involve patients in treatment decision making will provide effective starting points to organize time in ways to accommodate individual patients.

References

  1. van der Horst DEM, Garvelink MM, Bos WJW, Stiggelbout AM, Pieterse AH. For Which Decisions is Shared Decision Making Considered Appropriate?- A Systematic Review. Patient Education and Counseling. 2023;106:3–16.

  2. Pieterse AH, Stiggelbout AM, Montori VM. Shared Decision Making and the Importance of Time. JAMA. 2019;322(1):25–26.

  3. Bomhof-Roordink H, Fischer MJ, van Duijn-Bakker N, Baas-Thijssen MC, van der Weijden T, Stiggelbout AM, Pieterse, AH. Shared Decision Making in Oncology: a Model Based on Patients’, Health Care Professionals’, and Researchers’ Views. Psycho-oncology. 2019;28(1):139–46.

  4. Frerichs W, Hahlweg P, Müller E, Adis C, Scholl I. Shared Decision-Making in Oncology-a Qualitative Analysis of Healthcare Providers’ Views on Current Practice. PloS one. 2016;11(3).

  5. Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not Power for Patients: a Systematic Review and Thematic Synthesis of Patient-Reported Barriers and Facilitators to Shared Decision Making. Patient Education and Counseling. 2014;94(3):291–309.

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