Patient values in cancer care: Insights for shared decision-making.

Abstract

395 Background: Shared decision making (SDM) is a collaborative approach that integrates patient values into cancer treatment decisions. Although SDM is a pillar of patient-centered care, discussions of patient values remain limited or absent in the clinic. Understanding and eliciting patient values remains poorly understood, and few evidence-based approaches exist to incorporate patient values into SDM models. The aim of this analysis is to understand how patients perceive and prioritize their values during their care and to identify ways to incorporate these values in SDM. Methods: We used a qualitative descriptive design to interview patients with advanced prostate cancer from March to June 2023. Participants were recruited from within the Duke University Hospital system using a purposive sampling approach. Interviews explored participants’ perceptions of and experiences with decision-making during treatment. We analyzed transcripts using thematic analysis. Results: A total of 26 individuals participated. Participants were most commonly White (n=22) and ranged from 50 to 79 years of age. Four themes emerged. First, participants describe decision-making being shaped by uncertainty, urgency, and optimism towards treatment outcomes. Participants balance considerations of quality of life and length of life with eradication of the cancer. Second, participants highlighted the influential role of support networks when making treatment decisions while also describing variation in how they engage with their network throughout treatment. Participants consider involving their spouse, attending support groups, and the role their clinicians play in providing individualized care. Third, hindsight shapes how patients perceive their cancer care retroactively, regret being a significant factor in the satisfaction of their care. Participants contend with their expected versus lived experience, having to manage unexpected side effects and frustration of a lack of information sooner in the treatment process. Fourth, the health system is a factor itself the influences shared decision making. Structures of clinics, clinician teams, and the roles of clinicians all influence the shared decision-making process. Conclusions: Patient values are dynamic and evolve throughout the course of treatment as individuals navigate uncertainty, treatment trade-offs, support networks, and health systems. Shared decision-making tools should move beyond brief, singular conversations and incorporate structured, longitudinal assessment of patient values. Ongoing elicitation and understanding of patient values is crucial for improvement and delivery of patient-centered care.