SCNs play an important role in educating and supporting people affected by cancer as they evaluate the benefits and risks associated with treatments.
A person diagnosed with cancer often faces a range of difficult decisions. Preferences for involvement in making decisions vary considerably. Health professionals are encouraged to assess individual preferences for involvement, acknowledging that preferences are likely to change over time and be influenced of many factors. Assessment of preference is therefore a process that should be conducted throughout the duration of the person's cancer journey.8 While most individuals prefer a collaborative role, a significant minority prefers to take a passive or inactive role. The association between specific individual factors such as age and gender and preferences or satisfaction related to collaborative decision making is not well understood.8
Different approaches to facilitating the person’s decision making have been described:9
- Traditional or paternalistic approach —decision making is left mainly to healthcare professionals, who generally make the decisions and recommend a particular course of action, often without involving healthcare consumers to any great extent in the decisions.
- Informed decision making — consumers make decisions based to some extent on information provided by professionals. The flow of information is mostly one way, from professionals to consumers.
- Partnership approach or shared decision making — consumers and professionals share relevant information (for example, about risks, benefits, consumer’s characteristics and values), and agree on decisions.
Despite moves towards more informed and partnership approaches, a mix of these different types of decision making is likely depending on the individuals involved and the circumstances.9 Health professionals are encouraged to assess individual preferences for involvement, acknowledging that preferences are likely to change over time and as a result of many influences. Assessment of preferences for decision making is a process that should be conducted throughout the duration of the person's cancer journey.8
Communication has been identified as an important element of treatment decision making. A tool kit(PDF, 688KB)9 has been developed to support health professionals and people affected by cancer communicate effectively to support decision making. Key principles in the toolkit include:9
Principle 1: Good communication between healthcare consumers and healthcare professionals has many benefits.
Principle 2: Healthcare consumers vary in how much participation in decision making they desire.
Principle 3: Good communication depends on recognising and meeting the needs of healthcare consumers.
Principle 4: Perception of risks and benefits are complex and priorities may differ between healthcare consumers and healthcare professionals.
Principle 5: Information on risks and benefits needs to be comprehensive and accessible.
Source: Making decisions about tests and treatments: Principles for better communication between healthcare consumers and healthcare professionals(PDF, 688KB). Australian Government. NHMRC. 20069
Providing information is a key component to support treatment decisions. When providing treatment information and supporting decision making with people with cancer the following issues should be considered:4
- Individuals will vary in their needs for information and their needs may change as treatment proceeds, requiring individualised responses by clinicians
- Individual preferences for communication styles vary, and clinicians need to tailor the format of information provision
- Information recall can be increased by simplifying the language, dividing the information into key issues, and repeating key messages
- Time information provision appropriately
- Individual preferences for the amount, detail and content of information varies and should be tailored to the individual and their circumstances and need
- Provision of a question prompt sheet may promote questions, reduce anxiety, improve recall and shorten the consultation
- Provision of reputable written, audio-visual, and / or online resources can support individual understanding and reinforce information provided
A number of resources are available to support standardised provision of information to support treatment decision making:
Radiation Therapy Patient Education Checklist. eviQ Cancer Treatments Online, 2014
eviQ Patient Information Sheets. eviQ Cancer Treatments Online, 2014
eviQ Question Prompt Lists. eviQ Cancer Treatments Online, 2014
Discuss the meaning of informed consent in the context of treatment decision making.
Outline how the SCN can promote autonomy in decision making.
Access the NHMRC tool kit(PDF, 688KB)9 , reflect on a clinical example, and discuss how the five principles were used or how their use may have improved the decision making process.
- Discuss the likely needs of people affected by cancer at each stage of treatment planning.
- Describe the key sources of information that a person affected by cancer can use to support treatment decisions.