Barriers and facilitators for shared decision-making in oncology inpatient practice: an explorative study of the healthcare providers' perspective

BACKGROUND: In cancer care, shared decision-making (SDM) is especially relevant as different treatment options have a different impact on prognosis and patients' quality of life. However, evidence suggests that SDM is not routinely practiced. Furthermore, literature is mostly focussed on the outpatient setting. This study explored healthcare providers' perspectives on SDM for oncology inpatients and identified barriers and facilitators.

METHOD: In this qualitative study, focus groups and semi-structured interviews were held with five nurses, eleven residents, four oncologists, and two healthcare managers caring for oncology inpatients of the Elisabeth-TweeSteden hospital.

RESULTS: Healthcare professionals do not always clearly state when a decision is required. On a patient level, comprehension barriers, language barrier, and distraction by emotions or sickness are recognized as barriers for adequate patient's communication. On a healthcare professional level, having awareness to inform about choices, being able to transfer this information, connecting to the patient, having substantial experience, and a good patient-physician relationship were facilitators. On an organizational, level, time, private rooms, continuity in care, and suboptimal use of the electronic health record were barriers.

CONCLUSION: While SDM is recognized and valued, its implementation is inconsistent. Addressing the several barriers found and optimizing the facilitators is imperative. A start could be by raising awareness for SDM in the inpatient setting, adding SDM as part of the care pathway, stating to patients when a decision is required, reporting on the SDM process in the electronic health record, and describing the nurses' role in SDM.