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Physician-Identified Factors Affecting Patient Participation in Reaching Treatment Decisions

Heather L. Shepherd, Martin H.N. Tattersall, Phyllis N. Butow

From the Medical Psychology Research Unit, Department of Cancer Medicine, and School of Psychology, University of Sydney, Sydney, Australia

Corresponding author: Heather Shepherd, Medical Psychology Research Unit, Blackburn Building (D06), University of Sydney, New South Wales 2006, Australia; e-mail: heathers{at}med.usyd.edu.au

Purpose Cancer physicians report high comfort with shared decision making but a lower frequency of using this approach in practice. Information regarding physicians’ perceptions of what helps and what hinders patient involvement in decision making may facilitate understanding of this discrepancy.

Methods We surveyed 604 Australian cancer physicians treating breast, colorectal, gynecologic, hematologic, or urologic cancer to investigate barriers and facilitators to reaching treatment decisions with their patients and their support of strategies to encourage patient involvement and reflection on treatment options. Factor analysis and regression analyses were used to investigate relationships between variables and identify predictors of greater reporting of barriers to sharing treatment decisions with patients.

Results Insufficient information at the first consultation (28.9%) and insufficient time (28.4%) were the most frequently reported barriers to reaching treatment decisions with patients. Multivariate analysis revealed that less experienced physicians more commonly reported system barriers (P = .00). Patients trusting their physician and being accompanied at the consultation were most helpful to reaching a treatment decision. Providing written information about treatment options, making a further appointment to reach a decision, encouraging the patient to speak with their family physician and treatment team, and the presence of a third person during the consultation were felt to encourage involvement and reflection on treatment decisions.

Conclusion Cancer physicians experience difficulties when reaching treatment decisions with their patients. Interventions and strategies that physicians support are required to enhance patient involvement in reaching a treatment decision.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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