Shared decision making in consultations about treatment for non small cell lung cancer

Lung Cancer accounts for between 10-15% of all new cases of cancer in the UK. Considering treatment for lung cancer is a complex process involving balancing the trade-off between quality and quantity of life. Guidelines (NICE 2005) emphasise that treatment decision making is an endeavour to be done jointly between doctors and patients. Current evidence suggests that involvement in decision making is beneficial for patients and can be achieved through using a shared decision making model. It is unclear how treatment decisions are currently made in lung cancer and what patients’ views on the process are. The current study aimed; first to examine the patient, companion and doctor interaction within lung cancer decision making consultations; second to explore if shared decision making is present; third to investigate patient satisfaction with the decision making process. A mixed method cross sectional survey design was used. A qualitative method was used to observe fourteen consultations, which were then coded for content using thematic analysis. A questionnaire was used to elicit patients’ views about the consultation. Data was analysed using descriptive statistics. Findings suggest that shared decision making was not routinely implemented in current practice. Seventeen themes were extracted around making sense of the patient’s lung cancer, discussing treatment options and their consequences, aspects of related care and social expectations. Consultations were largely focused on the exchange of information, which did not happen fully. Patients’ values were not elicited and participants did not deliberate the decision together. Consultations consistently helped the patient to understand their prognosis, and the best clinical direction to take and consent to. However patients are not actively involved in the decision making. If shared decision making is to be used in clinical practice the structure of the consultation needs to be adapted to create space for patients to be supported through deliberating the decision in addition to talking about options and choices.