Shared decision-making in cancer care in Bangladesh: evidence from a resource-constrained setting

Shared decision-making (SDM) is a key component of patient-centered cancer care; however, its implementation remains poorly understood in resource-limited settings like Bangladesh. The purpose of this survey is to assess the prevalence of SDM, identify its associated factors, and evaluate its impact on patient satisfaction within this context.

We conducted a cross-sectional survey using convenience sampling between May and July 2024 at a tertiary care specialized cancer hospital in Bangladesh. Eligible participants were adult patients with cancer who had received at least two cycles of chemotherapy or radiation therapy and had the physical and decisional capacity to participate. Chi-square tests assessed bivariate associations, and multivariable logistic regression, adjusted for age, education, and treatment modality, identified independent predictors of SDM participation.

Among 231 participants (mean [SD] age, 51.6 [13.2] years), 55% were women and 91% were not in formal employment. Overall, 32% of patients reported participating in SDM, whereas 59% expressed a preference for it. Patients with no formal education had 85% lower odds of participating in SDM compared to those with schooling (adjusted odds ratio [AOR], 0.15; 95% confidence interval [CI] 0.06–0.38; P < 0.001). Compared to the youngest group, middle-aged patients had 89% lower odds of participating in SDM (AOR, 0.11; 95% CI 0.04–0.31; P < 0.001), and older patients had 95% lower odds (AOR, 0.05; 95% CI 0.01–0.18; P < 0.001). Working patients had over four times the odds of engaging in SDM compared to non-working patients (AOR, 4.24; 95% CI 2.25–10.17; P = 0.001). Actual involvement in SDM, desire for additional information, and preferred decision-making role were significantly associated with satisfaction (P < 0.001 for all).

The significant disconnect between patients' high preference for and low participation in SDM highlights a critical gap in patient-centered oncology care in Bangladesh. Systemic barriers, such as severe time constraints and low health literacy, must be addressed through targeted interventions, including clinician training and the development of low-literacy decision aids, to advance equitable cancer care.