Shared decision-making in radiotherapy: patients’ needs and experiences

ESTRO 2024 Congress report

Shared decision-making (SDM) is a collaborative process in which patients and healthcare providers together decide on the best treatment option for the patient. This process goes beyond consideration of just clinical factors, and seeks the patient’s personal preferences and awareness of their circumstances. While the discourse on SDM has been ongoing for nearly 25 years – and has led to suggestions of various beneficial effects for both patients and physicians – its integration into clinical practice has proven to be challenging. As radiotherapy is a highly specialised and protocolised field, patients’ experiences and needs regarding SDM may differ from those in other specialisations. Consequently, the aims of this study were to gauge patient interest in SDM in radiotherapy and to assess the extent to which they experienced SDM at Maastro Clinic, which is an academic radiotherapy centre in Maastricht, The Netherlands.

Patients who had undergone an intake consultation at Maastro between 2020 and 2022 were invited to take part in the survey. This survey was derived from an earlier study conducted by Kuijpers and colleagues in 2022, and was adapted to fit the radiotherapy context. A total of 1799 patients responded to the survey, and they represented a wide range of primary tumours, ages and educational levels. Most (88.3%) said that they often or always preferred SDM in radiotherapy. Minor differences could be observed in preferences across tumour sites; breast cancer patients had a comparatively positive attitude towards SDM (89.8%) and gastrointestinal cancer patients were comparatively less likely to prefer SDM (84.7%). In contrast, only 23.1% of patients reported that they had experienced the making of a choice, by either themselves or their radiation oncologists, during their intake. When this group was narrowed down to only those patients who reported more than one treatment option, this number shrank to 11.6% of patients. Again, rates varied across tumour sites (from 18.9% of head-and-neck to 7.4% of gastrointestinal cancer patients).

To our knowledge, this is the first study that has assessed patient-reported SDM needs and experiences in the radiotherapy context. Our results indicate that patients who receive radiotherapy may have an unmet need for SDM. This could be seen as a call to action to reflect critically on patient-physician communication in radiotherapy during their appointments, and to consider the influences that may affect perceptions of SDM both earlier and later in the patient journey. These influences may include the quality, quantity and timing of information that is offered, the relationship with the referring physician, and the number of treatment options that are recommended by multidisciplinary tumour boards and presented by the physician. These insights should be translated into theory and/or evidence-based strategies such as training that can facilitate radiation oncologists to embrace SDM in their daily practice, and it should be evaluated through the use of validated instruments to measure patients’ SDM experiences.

Anniek Rosalie van Hienen

anniek.vanhienen@maastro.nl

https://nl.linkedin.com/in/anniek-van-hienen

Bluesky: anniekvanhienen@bsky.social

Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands