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Shared decision making in palliative cancer care: a literature review

Published online by Cambridge University Press:  08 November 2013

C. Feuz
C. Feuz*
Affiliation:
Princess Margaret Cancer Centre, Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
*
Correspondence to: Carina Feuz, Princess Margaret Cancer Centre, Department of Radiation Oncology, University Health Network, University of Toronto, 610 University Avenue Rm 6-103, Toronto, Ontario, Canada M5G 2M9. Tel: +416 946 4501×3197. Fax: +416 946 2019. E-mail: [email protected]
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Abstract

Background

Patients require information to make informed decisions and consent to medical treatment. Shared decision making (SDM) is a methodology that promotes a patient-centred approach to informed consent and demonstrates respect for autonomy

Purpose

The purpose of this paper is to critically review the legal and ethical issues relevant to Canadian and UK informed consent and SDM practices and how these processes relate to current palliative care practices, with a particular emphasis on radiation therapy.

Methodology

A review of the English literature from 2003 to 2013 was performed using the databases PubMed (NML), OVID Medline and Google Scholar.

Results and Conclusions

The literature identifies that palliative cancer patients desire the opportunity to be involved with decision-making discussions, which has shown to increase knowledge and result in better health-related outcomes. However, ethical and legal issues regarding the practicality of including this patient population in SDM discussions raises questions about validity of consent. For SDM to be considered a valid methodology to obtain informed consent, open and honest communication between the patient and multidisciplinary team is essential. Treatment options for palliative cancer patients are often complex and SDM allows healthcare professionals and patients to exchange information and negotiate feasible treatment options based on medical expertise and patient preferences.

Legal frameworks have defined current standards of practice for various healthcare professions, including radiation therapy. Radiation therapists, as members of the multidisciplinary team, are currently key contributors in providing information to patients regarding the radiotherapy process. Individuals working within advanced practice roles have the ability to develop skills once considered to be within medical domains and have begun to incorporate the delegated act of obtaining informed consent into practice which has shown to increase professional autonomy, accountability and improves patient-centred care.

Keywords

cancerinformed consentpalliative careshared decision making
Type
Literature Reviews
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 3 , September 2014 , pp. 340 - 349
Copyright
Copyright © Cambridge University Press 2013 

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References

1.World Health Organization (WHO). The solid facts: palliative care. www.euro.who.int/en/what-we-publish/abstracts/palliative-care.-the-solid-facts. Accessed on 10th December 2012.Google Scholar
2.National Institute for Clinical Excellence (NICE). Improving suppotive and palliative care for adults with cancer. http://guidance.nice.org.uk/CSGSP. Accessed on 9th December 2012.Google Scholar
3.Freeman, C, Lamed, H, Gingras, C, Shenouda, G. Consent to external-beam radiotherapy. Curr Oncol 2010; 17 (6): 9–11.CrossRefGoogle ScholarPubMed
4.Purtilo, R B, Doherty, R F. Ethical Dimensions in the Health Care Professions, 5th edition. Missouri: Elsevier Saunders, 2011.Google Scholar
5.Rogg, L, Aasland, O, Graugaard, P K, Loge, J H. Direct communication, the unquestionable ideal? Oncologists’ accounts of communication of bleak prognoses. Psychooncology 2010; 19: 1221–1228.CrossRefGoogle ScholarPubMed
6.Mendelson, D, Stoltzfus Jost, T. A comparative study of the law of palliative care and end-of-life treatment. J Law Med Ethics 2003; 31: 130–143.CrossRefGoogle ScholarPubMed
7.Canadian Hospice and Palliative Care Association (CHPCA). A model to guide hospice palliative care. http://www.chpca.net/media/7422/a-model-to-guide-hospice-palliative-care-2002-urlupdate-august2005.pdf. Accessed on 11th December 2012.Google Scholar
8.Canadian Hospice and Palliative Care Association (CHPCA). Canadian hospice palliative care nursing standards of practice. http://www.chpca.net/media/7505/Canadian_Hospice_Palliative_Care_Nursing_Standards_2009.pdf. Accessed on 11th December 2012.CrossRefGoogle Scholar
9.Department of Health. Reference Guide to Consent for Examination, 2nd edition. 2009, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_103643. Accessed on 10th December 2012.Google Scholar
10.College of Medical Radiation Technologists of Ontario (CMRTO). Standards of practice. http://www.cmrto.org/resource/standards-practice.asp. Accessed on 9th December 2012.Google Scholar
11.College of Physicians and Surgeons of Ontario (CSPO). Policy statement: consent to medical treatment. http://www.cpso.on.ca/uploadedfiles/policies/policies/policyitems/Consent.pdf?terms=consent. Accessed on 11th December 2012.Google Scholar
12. Service Ontario. Health Care Consent Act, 1996. http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_96h02_e.htm. Accessed on 10th December 2012.Google Scholar
13.Berger, J T. Redefining the domains of decision making by physician and patient. The International Journal of Clinical Practice 2011; 65 (8): 828–830.CrossRefGoogle ScholarPubMed
14.Leighl, N B, Butow, P N, Tattersall, M H N. Treatment decision aids in advanced cancer: when the goal is not cure and the answer is not clear. J Clin Oncol 2004; 22 (9): 1759–1762.CrossRefGoogle Scholar
15.Schenker, Y, Meisel, A. Informed consent in clinical care. JAMA 2011; 305 (11): 1130–1131.Google ScholarPubMed
16.Thorne, S, Oliffe, J L, Stajduhar, K I. Communicating shared decision-making: cancer patient perspectives. Patient Educ Couns 2012; 90 (3): 291–296.CrossRefGoogle ScholarPubMed
17.General Medical Council (GMC). Consent: patients and doctors making decisions together guidance. http://www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_index.asp. Accessed on 9th December 2012.Google Scholar
18.Falagas, M E, Korbila, I P, Giannopoulou, K, Kondilis, B K, Peppas, G. Informed consent: how much and what do patients understand? Am J Surg 2009; 198: 420–435.CrossRefGoogle ScholarPubMed
19.Kagan, A R. Informed consent. Int J Radiat Oncol Biol Phys 2004; 59 (3): 634–636.CrossRefGoogle ScholarPubMed
20.Verhaak, C M, Kraaimaat, F W, Staps, A C J, van Daal, W A J. Informed consent in palliative radiotherapy: participation of patients and proxies in treatment decisions. Patient Educ Couns 2000; 41: 63–71.CrossRefGoogle ScholarPubMed
21.Albrecht, T L, Franks, M M, Ruckdeschel, J C. Communication and informed consent. Curr Opin Oncol 2005; 17: 336–339.CrossRefGoogle ScholarPubMed
22.Mazur, D. How successful are we at protecting preferences? Consent, informed consent, advanced directives and substituted judgment. Med Decis Making 2006; 26: 106–109.CrossRefGoogle ScholarPubMed
23.Pace, N, Hendry, R. Consent: legal requirements and implications. Anesth Intensive Care Med 2006; 7 (4): 110–113.CrossRefGoogle Scholar
24.Schenker, Y, Fernandez, A, Sudore, R, Schillinger, D. Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review. Med Decis Making 2011; 31: 151–173.CrossRefGoogle ScholarPubMed
25.Timmermans, L M, van der Maazen, R W M, Verhaak, C M, van Roosmalen, M S, van Daal, W A J, Kraaimaat, F W. Patient participation in discussing palliative radiotherapy. Patient Educ Couns 2005; 57: 53–61.CrossRefGoogle ScholarPubMed
26.Edwards, M, Davies, M, Edwards, A. What are the external influences on information exchange and shared decision-making in healthcare consultations: a meta-synthesis of the literature. Patient Educ Couns 2009; 75: 37–52.CrossRefGoogle ScholarPubMed
27.Gaston, C, Mitchell, G. Information giving and decision-making in patients with advanced cancer: a systematic review. Soc Sci Med 2005; 61: 2252–2264.CrossRefGoogle ScholarPubMed
28.Karnieli-Miller, O, Eisikovits, Z. Physician as partner or salesman? Shared decision-making in real-time encounters. Soc Sci Med 2009; 69 (1): 1–8. doi:10.1016/jsocscimed.2009.1004.1030.CrossRefGoogle ScholarPubMed
29.Heywood, R, Macaskill, A, Williams, K. Informed consent in hospital practice: health professionals’ perspectives and legal reflections. Med Law Rev 2010; 18: 152–184.CrossRefGoogle ScholarPubMed
30.Gattellari, M, Voigt, K J, Butow, P N, Tattersall, M H N. When the treatment goal is not cure: are cancer patients equipped to make informed decisions. J Clin Oncol 2002; 20 (2): 503–513.CrossRefGoogle Scholar
31.Addington-Hall, J. Research sensitivities to palliative care patients. Eur J Cancer Care 2002; 11: 220–224.CrossRefGoogle ScholarPubMed
32.Rees, E. The ethics and practicalities of consent in palliative care research: an overview. Int J Palliat Nurs 2001; 7 (10): 489–492.CrossRefGoogle ScholarPubMed
33.Bakitas, M, Kryworuchko, J, Matlock, D D, Volandes, A E. Palliative medicine and decision science: the critical need for a shared agenda to foster informed patient choice in serious illness. J Palliat Med 2011; 14 (10): 1109–1116.CrossRefGoogle ScholarPubMed
34.Clayton, J, Hancock, K, Parker, Set al. Sustaining hope when communicating with terminally ill patients and their families: a systematic review. Psychooncology 2008; 17: 641–659.CrossRefGoogle ScholarPubMed
35.Gripp, S, Mjartan, S, Boelke, E, Willers, R. Palliative radiotherapy tailored to life expectancy in end-stage cancer patients. Cancer 2010; 116: 3251–3256.Google ScholarPubMed
36.Keating, N L, Landrum, M B, Rogers, S Oet al. Physician factors associated with discussion about end-of-life care. Cancer 2010; 116 (4): 998–1006.CrossRefGoogle ScholarPubMed
37.Grunfeld, E A, Maher, E J, Browne, Set al. Advanced breast cancer patients’ perceptions of decision making for palliative chemotherapy. J Clin Oncol 2006; 24 (7): 1090–1098.CrossRefGoogle ScholarPubMed
38.Belanger, E, Rodriguez, C, Groleau, D. Shared decision-making in palliative care: a systematic mixed studies review using narrative synthesis. Palliat Med 2010; 25 (3): 242–261.CrossRefGoogle Scholar
39.Song, L, Chen, R C, Bensen, J Tet al. Who makes the decision regarding the treatment of clinical localized prostate cancer: the patient or physician? Cancer 2012; 119 (2): 421–428.Google ScholarPubMed
40.van Kleffens, T, van Baarsen, B, van Leeuwen, E. The medical practice of patient autonomy and cancer treatment refusals: a patients’ and physicians perspective. Soc Sci Med 2004; 58: 2325–2336.CrossRefGoogle ScholarPubMed
41.Ho, A. Relational autonomy or undue pressure? Family's role in medical decision-making. Scand J Caring Sci 2008; 22 (1): 128–135.CrossRefGoogle ScholarPubMed
42.Audrey, S, Abel, J, Blazeby, J M, Falk, S, Campbell, R. What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study. BMJ 2008; 337: a752: doi:710.1136/bmj.a1752.CrossRefGoogle ScholarPubMed
43.Timmermans, L M, van der Maazen, R W M, Leer, J W H, Kraaimaat, F W. Palliative or curative treatment intent affects communication in radiation therapy consultations. Psychooncology 2006; 15: 713–725.CrossRefGoogle ScholarPubMed
44.Koedoot, C G, de Hann, R J, Stiggelbout, A Met al. Palliative chemotherapy or best supportive care? A prospective study explaining patients’ treatment preference and choice. Br J Cancer 2003; 89: 2219–2226.CrossRefGoogle ScholarPubMed
45.Walsh, M C, Trentham-Dietz, A, Schroepfer, T Aet al. Cancer information sources used by patients to inform and influence treatment decisions. J Health Commun 2010; 15: 445–463.CrossRefGoogle ScholarPubMed
46.Keating, N L, Landrum, M B, Arora, N Ket al. Cancer patients’ role in treatment decisions: do characteristics of the decision influence roles? J Clin Oncol 2010; 28 (28): 4364–4370.Google ScholarPubMed
47.College of Medical Radiation Technologists of Ontario (CMRTO). Code of ethics. http://www.cmrto.org/resource/code-ethics.asp. Accessed on 10th December 2012.Google Scholar
48.Schenker, Y, Wang, F, Selig, S J, Ng, R, Fernandez, A. The impact of language barriers on documentation of informed consent at a hospital with on-site interpreter services. Journal of General Internal Medicine 2007; 22 (suppl 2): 294–299.CrossRefGoogle Scholar
49.Moulton, B, King, J S. Aligning ethics with medical decision-making: the quest for informed patient choice. J Law Med Ethics 2010; 38 (1): 85–97.CrossRefGoogle ScholarPubMed
50.Hickman, S E, Cartwright, J C, Nelson, C A, Knafl, K. Compassion and vigilance: investigators’ strategies to manage ethical concerns in palliative and end-of-life research. J Palliat Med 2012; 15 (8): 880–889.CrossRefGoogle ScholarPubMed
51.Sibbald, R W, Chidwick, P. Best interests at the end of life: a review of decisions made by the Consent and Capacity Board of Ontario. J Crit Care 2010; 25: e171–e177.Google ScholarPubMed
52.Feuz, C. Hoping for the best while preparing for the worst: a literature review of the role of hope in palliative cancer patients. J Med Imaging Radiat Sci 2012; 43 (3): 168–174.CrossRefGoogle ScholarPubMed
53.Mack, J, Wolfe, J, Cook, E F, Grier, H E, Cleary, P D, Weeks, J C. Hope and prognostic disclosure. J Clin Oncol 2007; 25 (35): 5636–5642.CrossRefGoogle ScholarPubMed
54.Colyer, H. Informed consent for radiotherapy: our responsibility. Radiography 2007; 13 (3): 197–201.Google Scholar
55.Smith, T J, Dow, L A, Virago, E A, Khatcheressian, J, Matsuyama, R, Lyckholm, L J. A pilot trial of decision aids to give truthful prognostic and treatment information to chemotherapy patients with advanced cancer. J Support Oncol 2011; 9 (2): 79–86.CrossRefGoogle ScholarPubMed
56.Fairley, D. Discovering the nature of advanced nursing practice in high dependency care: a critical care nurse consultant's experience. Intensive Crit Care Nurs 2005; 21: 140–148.CrossRefGoogle Scholar
57.Halkett, G K B, Kristjanson, L J. Patients’ perspectives on the role of radiation therapists. Patient Educ Couns 2007; 69: 76–83.CrossRefGoogle ScholarPubMed
58.Halkett, G K B, Merchant, S, Jiwa, Met al. Effective communication and information provision in radiotherapy – the role of radiation therapists. J Radiother Practice 2010; 9 (1): 3–16.Google Scholar
59. Department of Health. 12 key points on consent: the law in England. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006131. Accessed on 10th December 2012.Google Scholar
60.Acharya, U, Acharya, V, Raja Vatsavayi, S, Cox, J. Systematic review – role expansion in radiation therapy: from an international perspective to an Australian context. Aust Inst Radiograph 2009; 56 (3): 38–43.Google Scholar
61.Shi, J, Cox, J, Atyeo, J, Loh, Y, Chuong, W L, Back, M. Clinician and therapist perceptions on radiation therapist-led treatment reviews in radiation oncology practice. Radiother Oncol 2009; 89: 361–367.CrossRefGoogle Scholar
62.White, P, McKay, J C. Guidelines and legal requirements which inform role expansion in radiography. Radiography 2002; 8: 71–78.Google Scholar