Experiences And Beliefs Regarding Shared Decision-Making About Treatment Of Incurable Cancer In Tanzania

Abstract Purpose: Treatment decision-making in the setting of advanced cancer is often complex and culturally embedded. Potential benefits of treatment must be weighed against toxicities, economic burden, and social consequences. The standard of shared decision-making (SDM) between doctor and patient, rooted in the Western principle of patient autonomy, may not be readily transferable to other cultural and socioeconomic contexts, where different values and considerations may take precedence. This study aims to characterize the decision-making experiences and beliefs of stakeholders at Ocean Road Cancer Institute (ORCI) in Tanzania in order to inform communication guidelines and improvement strategies. Methods: We conducted semi-structured interviews with a purposive sample of oncologists and nurses (n=13) and patients with advanced cancer (n=11) at ORCI. A diagram depicting paternalistic, informed, and shared approaches to decision-making was referenced during interviews. Interviews were recorded, transcribed verbatim, translated to English, coded using MAXQDA software, and analyzed using framework thematic analysis. Results: Patients and providers reported heterogeneous decision-making experiences and preferences, with a trend toward greater patient engagement in recent years. Providers believed SDM is especially important when treatment goals are palliative and when out-of-pocket costs are significant, but favored paternalistic decision-making in the context of curative treatment and lower patient health literacy. Patients generally placed greater importance on providers' communication style and the quality of clinical care than engagement in SDM. Several participants perceived SDM to increase patient adherence to treatment. Barriers and facilitators of SDM were identified at the patient, provider, and healthcare system levels. Community misperceptions about cancer treatment was commonly cited as a barrier. Practical suggestions included communication skills training for providers, implementation of a clinical tool for decision-making, and increased patient and public education about cancer treatment. Conclusion: Understanding the nuanced views regarding SDM is important for development of culturally informed communication guidelines, tools, and training. Citation Format: Megan Casey, Raymond Athanas, Nazima Dharsee, Anna Jazza, Kalunde Julius, Francis Semwaza, Beatrice Mushi, Emilie Kadhim, Katherine Van Loon, Anita Ho, Rebecca Deboer. Experiences and Beliefs Regarding Shared Decision-Making About Treatment of Incurable Cancer in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 57.