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Potential Adverse Outcomes of Shared Decision Making about Palliative Cancer Treatment: A Secondary Analysis of a Randomized Trial

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  • Loïs F. van de Water

    (Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
    Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
    Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
    Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands)

  • Danique W. Bos–van den Hoek

    (Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
    Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
    Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands)

  • Steven C. Kuijper

    (Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
    Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands)

  • Hanneke W. M. van Laarhoven

    (Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
    Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands)

  • Geert-Jan Creemers

    (Department of Medical Oncology, Catharina Ziekenhuis, Eindhoven, The Netherlands)

  • Serge E. Dohmen

    (Department of Medical Oncology, BovenIJ, Amsterdam, The Netherlands)

  • Helle-Brit Fiebrich

    (Department of Medical Oncology, Isala Klinieken, Zwolle, The Netherlands)

  • Petronella B. Ottevanger

    (Department of Medical Oncology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands)

  • Dirkje W. Sommeijer

    (Department of Medical Oncology, Flevoziekenhuis, Almere, The Netherlands)

  • Filip Y. F. de Vos

    (Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands)

  • Ellen M. A. Smets

    (Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
    Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
    Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands)

  • Inge Henselmans

    (Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
    Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands)

Abstract

Background While shared decision making (SDM) is advocated for ethical reasons and beneficial outcomes, SDM might also negatively affect patients with incurable cancer. The current study explored whether SDM, and an oncologist training in SDM, are associated with adverse outcomes (i.e., patient anxiety, tension, helplessness/hopelessness, decisional uncertainty, and reduced fighting spirit). Design A secondary analysis of a randomized clinical trial investigating the effects of SDM interventions in the context of advanced cancer. The relations between observed SDM (OPTION12), specific SDM elements (4SDM), oncologist SDM training, and adverse outcomes were analyzed. We modeled adverse outcomes as a multivariate phenomenon, followed by univariate regressions if significant. Results In total, 194 patients consulted by 31 oncologists were included. In a multivariate analysis, observed SDM and adverse outcomes were significantly related. More specifically, more observed SDM in the consultation was related to patients reporting more tension ( P  = 0.002) and more decisional uncertainty ( P  = 0.004) at 1 wk after the consultation. The SDM element “informing about the options†was especially found to be related to adverse outcomes, specifically to more helplessness/hopelessness ( P  = 0.002) and more tension ( P  = 0.016) at 1 wk after the consultation. Whether the patient consulted an oncologist who had received SDM training or not was not significantly related to adverse outcomes. No relations with long-term adverse outcomes were found. Conclusions It is important for oncologists to realize that for some patients, SDM may temporarily be associated with negative emotions. Further research is needed to untangle which, when, and how adverse outcomes might occur and whether and how burden may be minimized for patients. Highlights Observed shared decision making was related to more tension and uncertainty postconsultation in advanced cancer patients However, training oncologists in SDM did not affect adverse outcomes. Further research is needed to untangle which, when, and how adverse outcomes might occur and how burden may be minimized

Suggested Citation

  • Loïs F. van de Water & Danique W. Bos–van den Hoek & Steven C. Kuijper & Hanneke W. M. van Laarhoven & Geert-Jan Creemers & Serge E. Dohmen & Helle-Brit Fiebrich & Petronella B. Ottevanger & Dirkje, 2024. "Potential Adverse Outcomes of Shared Decision Making about Palliative Cancer Treatment: A Secondary Analysis of a Randomized Trial," Medical Decision Making, , vol. 44(1), pages 89-101, January.
    • Handle: RePEc:sae:medema:v:44:y:2024:i:1:p:89-101
    DOI: 10.1177/0272989X231208448
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    References listed on IDEAS

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    1. Michael Saheb Kashaf & Elizabeth McGill, 2015. "Does Shared Decision Making in Cancer Treatment Improve Quality of Life? A Systematic Literature Review," Medical Decision Making, , vol. 35(8), pages 1037-1048, November.
    2. L. Aubree Shay & Jennifer Elston Lafata, 2015. "Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes," Medical Decision Making, , vol. 35(1), pages 114-131, January.
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