Through Clinicians' Eyes: Use of an In-consultation Patient Decision Aid in Radiotherapy Treatment for Early Breast Cancer. A Qualitative Study

Introduction Shared decision making (SDM) has become a crucial element on the political agenda and represents a vital aspect of modern healthcare. However, successful implementation of SDM highly depends on the attitude of clinicians towards SDM. The overall aim of our study was to explore the experience of oncologists and nurses with SDM using the Decision Helper, an in-consultation decision aid, at four Danish radiotherapy departments. Methods Semi-structured interviews were conducted with 20 clinicians. The participants were selected using purposive sampling to include nurses and oncologists, male and female, with different levels of experience with SDM and clinical work. The analysis was a data-driven, iterative process with inductive coding of all interviews and meaning condensation. Results Two main themes emerged: “Using the Decision Helper changes the consultation” and “Change of attitude among Danish oncologists”. Each of the two themes included four elaborative subthemes, which are reported with supporting citations in this paper. In brief, the use of SDM and the Decision Helper should ideally be adjusted to the individual patient and depends highly on the oncologist. The participants described ambitions towards "making the right decision for this patient at this time”. The healthcare system, however, has pitfalls that may hinder SDM, e.g. rigid interpretation of guideline-based recommendations. Conclusion Using an in-consultation Decision Helper has the potential for individualized, structured patient engagement in decision making. There is a need for patient decision aids in clinical guidelines to ensure patient engagement in decision making. Micro Abstract Clinicians’ experience of shared decision making and their use of patient decision aids are crucial for the implementation of shared decision making. Fourteen oncologists and six nurses share their experiences in this paper. Overall, while our findings indicate that the use of an in-consultation patient decision aid (the Decision Helper) requires a change in their practice, the clinicians report that using decision aids has the potential for individualized, structured patient involvement in decision making.