Clinician perspectives on shared decision-making

Shared decision-making (SDM) between physician and patient is now widely considered to be a desirable goal in many healthcare contexts. However, little is known about current SDM practice in cancer care. Moreover, there are few data about physician perceptions of SDM or about outcomes for cancer patients. Now, most cancer patients are told the diagnosis, and expect to be informed about their disease and its treatment. There are many reasons for the recent increased emphasis on patients' rights. As communities have become better educated and information about healthcare issues has become more accessible, a fundamental shift in society's expectations of the appropriate role for physicians has occurred. Surveys of patients with advanced cancer have revealed not only that patients' desire for information and involvement in decision-making is high, but also that patients whose condition has recently worsened are more likely to want progressively less involvement in decision-making. This chapter reviews the literature pertaining to the potential relevance of the particular patient circumstance and the consequences for embracing SDM.