Shared decision-making in the treatment of non-small cell lung cancer stage I-IV: perspectives from patients and clinicians

Abstract

Background: Decision-making in non-small cell lung cancer (NSCLC) is complex and value-sensitive. A shared decision-making (SDM) approach is desirable to effectively weigh clinical considerations and patient preferences. However, implementing effective SDM remains challenging.

Objectives: This study explores the perspectives of patients with NSCLC and clinicians regarding SDM, identifying barriers and facilitators.

Methods: Two surveys were conducted: one with Dutch patients (n=116) and another with Dutch clinicians (n=143). The patient survey included demographics, treatment knowledge, information provision, decisional conflict scale and SDM. The clinician survey included demographics, patient information provision, treatment preferences (surgery vs radiation) using a 7-point Likert scale for five hypothetical cases, and SDM.

Results: Patients lacked knowledge about the advantages and disadvantages of different treatment options, especially regarding radiotherapy for early-stage NSCLC. 85% of patients and 70% of clinicians believed the final treatment decision should be made collaboratively. However, 69% of patients reported not being offered a choice of treatment options. Preferences varied significantly among specialties (p<0.01) in three out of five hypothetical cases.

Discussion: This study underscores the importance of SDM in NSCLC treatment, revealing gaps in patient knowledge, clinician SDM skills and information provision.

Conclusions: Significant discrepancies between patient and clinician perspectives, along with variation in treatment approaches, highlight the need for more personalised, patient-centred care, such as information portals and decision aids, in clinical practice.

Keywords: Lung Cancer; Non-Small Cell Lung Cancer.