A cross-sectional analysis to characterise treatment decision making for advanced cancer at a tertiary treatment centre: Where can we improve the process?

Purpose: In decisions relating to cancer treatment, the risks and benefits of treatment and the patient's preferences must be considered to ensure concordance with goals of care. Shared decision making (SDM) can facilitate these discussions and is associated with reduced decision conflict. This study aimed to characterise decision making for advanced cancer patients at a UK tertiary cancer centre and identify who may be at risk of suboptimal SDM and increased decision conflict. Methods: Participants completed the SDM-Q-9, decision conflict and decision self-efficacy scale following a consultation where an advanced cancer treatment decision was made. Pearson's chi-square test identified patient characteristics associated with SDM-Q-9, decision self-efficacy and decision conflict score categories; odds ratios were calculated to determine which patients were at increased probability of experiencing suboptimal SDM, low decision self-efficacy or high decision conflict. Results: Participant's (n = 211) scores indicated predominantly high SDM, high decision self-efficacy and low decision conflict. Patient gender and the presence of an informal caregiver in consultation were significantly associated with SDM-Q-9 score category (p > 0.05). Female patients (OR = 2.466, 95% CI: 1.223-4.974) and those attending consultations alone (OR = 0.440, 95% CI: 0.222-0.874) had greater odds of reporting lower SDM scores. Conclusion: High SDM scores indicate either effective SDM behaviours or satisfaction with care biasing responses. Greater support to engage with SDM is required for female patients and those who attend alone in advanced cancer treatment decision consultations.