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01-04-2018 | Original Article

Triadic treatment decision-making in advanced cancer: a pilot study of the roles and perceptions of patients, caregivers, and oncologists

Authors: Thomas W. LeBlanc, Nick Bloom, Steven P. Wolf, Sarah G. Lowman, Kathryn I. Pollak, Karen E. Steinhauser, Dan Ariely, James A. Tulsky

Published in: Supportive Care in Cancer | Issue 4/2018

Abstract

Purpose

The research on cancer treatment decision-making focuses on dyads; the full “triad” of patients, oncologists, and caregivers remains largely unstudied. We investigated how all members of this triad perceive and experience decisions related to treatment for advanced cancer.

Methods

At an academic cancer center, we enrolled adult patients with advanced gastrointestinal or hematological malignancies, their caregivers, and their oncologists. Triad members completed a semi-structured qualitative interview and a survey measuring decisional conflict and perceived influence of the other triad members on treatment decisions.

Results

Seventeen patients, 14 caregivers, and 10 oncologists completed the study. Patients and caregivers reported little decisional regret and voiced high satisfaction with their decisions, but levels of decisional conflict were high. We found sizeable disagreement among triad members’ perceptions and preferences. For example, patients and oncologists disagreed about the caregiver’s influence on the decision 56% of the time. In addition, many patients and caregivers preferred to defer to their oncologist about treatment decisions, felt like no true decision existed, and disagreed with their oncologist about how many treatment options had been presented.

Conclusions

Patients, caregivers, and oncologists have discordant perceptions of the cancer treatment decision-making process, and bring different preferences about how they want to make decisions. These data suggest that oncologists should assess patients’ and caregivers’ decisional preferences, explicitly signal that a decision needs to be made whenever approaching an important crossroads in treatment and ensure that patients and caregivers understand the full range of presented options.

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Title: Triadic treatment decision-making in advanced cancer: a pilot study of the roles and perceptions of patients, caregivers, and oncologists
Authors: Thomas W. LeBlanc
Nick Bloom
Steven P. Wolf
Sarah G. Lowman
Kathryn I. Pollak
Karen E. Steinhauser
Dan Ariely
James A. Tulsky
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 4/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-3942-y

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Abstract

Purpose

Methods

Results

Conclusions

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