Communicating shared decision-making: cancer patient perspectives.

OBJECTIVE: To contribute to the evolving dialogue on optimizing cancer care communication through systematic analyzes of patients' perspectives.
METHODS: Using constant comparative analysis, inductively derived thematic patterns of communication preferences for shared decision-making were drawn from individual interviews with 60 cancer patients.
RESULTS: Thematic patterns in how patients understand barriers and facilitators to communication within shared decision-making illuminate the basis for distinctive patient preferences and needs. Prevailing cancer communication considerations included focusing attention on the tone and setting of the consultation environment, the attitudinal climate within the consult, the specific approach to handling numerical/statistical information, and the critical messaging around hope. The patient accounts surfaced complex dynamics whereby the experiences of living with cancer permeated interpretations and enactment of the shared decision-making that is emerging as a dominant ideal of cancer care.
CONCLUSION: In our efforts to move beyond traditional paternalism, shared decision-making has been widely advocated as best practice in cancer communication. However, patient experiential evidence suggests the necessity of a careful balance between standardized approaches and respect for diversities. PRACTICE IMPLICATIONS: Shared decision-making as a practice standard must be balanced against individual patient preferences. Crown