More on Decision Making

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

DECEMBER 21, 2017

Yesterday's entry was about the importance of shared decision-making.Today I continue the general theme, but with a slight shift to consider whether there is such a thing as true informed consent in cancer care. As patients have been more involved in choices, many feel compelled to become mini-experts on the particular disease or treatment. The truth, of course, is that, no matter how many facts one crams, we are never going to know as much as our doctors do.

Before I continue with this, I want to take a complete detour. Today is office moving day. Yesterday was spent packing up the space where I have been for more than twenty years, and today I am setting into the new one. It is just down the hall, and I am v grateful to still be on Shapiro 9 and to have a window. One of yesterday's patients began to weep at the end of our session. She spoke eloquently about leaving that room for the last time, recognizing all the pain and suffering it has witnessed--as well as all the laughter and joy and community. I am grateful to her for putting me in touch with all those feelings, and I, too, said a silent and grateful good-bye to that room full of memories.

And back to the topic. This is a v good article from Stat about this topic:

Informed decision making in cancer care: more myth than reality

By Ellen Miller-Sonet

For nearly a decade, the most distinguished minds in cancer care have advocated for shared decision-making1 — patients partnering with their clinicians to make informed decisions that are consistent with their needs, values, and preferences.

Although widely perceived as the gold standard, it seems to be the exception rather than the rule.

My organization, CancerCare, has surveyed2 more than 3,000 American adults with cancer. Many of them noted that during their planning for treatment they did not have enough information about other treatment options, whether they would be able to work, the care they’d need at home, the cost of treatment, caregiver responsibilities, and opportunities for joining a clinical trial. That doesn’t sound like informed decision-making to me.

Many factors influence cancer treatment decisions, including safety, effectiveness, and cost. The emergence of new decision-support tools — value frameworks, pathways, guidelines, and the like — is helping inform physicians’ recommendations. But most of these tools are shaped through the eyes of providers and payers, and often ignore what matters most to patients.

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