Article Text

Download PDFPDF
190 ‘Timelining’ treatment trajectories during interviews about shared decision making with ethnic minorities in oncology: a reflection on the method
  1. Roukayya Oueslati1,2,
  2. Anne M Stiggelbout3,4,
  3. Dorothea P Touwen1
  1. 1Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Nursing, The Hague University of Applied Sciences, The Hague, The Netherlands
  3. 3Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands


Introduction Limited research is available on ethnic minority patients’ experiences with shared decision making (SDM) in oncology. In the Netherlands, they are expected to increasingly make use of oncological care and face treatment decisions for which SDM is appropriate. SDM has been criticized for treating encounters independently and insufficiently taking influential factors outside the consultation room into account. The aim of this study was to assess the use of a combination of interviewing with drawing timelines (timelining) to gain insight in ethnic minorities’ oncological treatment trajectories.

Methods We interviewed patients (n=22) and relatives (n=11) with a Moroccan, Turkish and Surinamese Hindustani background, diagnosed with various types of cancer in different stages of their treatment trajectory, about decision-making. We combined interviewing with timelining.

Results During the interview, timelines functioned as a memory aid for the researcher and enabled her to familiarize herself with the patients’ trajectories. Timelines helped respondents to remember and focus on decisional moments and to ‘see’ their treatment trajectory through a lens of decision-making. This can intensify respondents’ emotions, but the visualization offers at the same time distraction as respondents could look at their experiences from a distance.

As the timelines developed, they became an actant to which respondents pointed and enabled the researcher to ask transcending questions about decision-making in the context of the whole treatment trajectory.

Discussion Through timelining we captured multiple treatment decisions and considered decision- making as a longitudinal process during which patients’ self-direction could change. Timelining should be adapted to individual patients regarding how much is drawn or written.

Conclusion(s) Timelining made decision-making more tangible for respondents and is a promising method to incorporate ethnic minorities’ experience into care path design to improve SDM.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.