Shared decision making in dermato-oncology: preference for involvement of melanoma patients

Increasing importance is being conferred to the implementation of shared decision making (SDM) in clinical practice for medical, ethical, and sociological reasons. In Germany, SDM has recently been adopted as an explicit goal in the S3-melanoma treatment guideline. The aim of this study is to present data on how melanoma patients want to be involved in treatment decisions and second on the dynamic of these preferences for involvement. This was investigated in consecutively recruited melanoma patients (stages I-III) in two German Skin Cancer Centers as part of a longitudinal questionnaire study. The Control Preference Scale assessed patients' preferences at baseline (n=405) and was readministered 1 year later (n=314) to detect potential changes. In addition, the perceived realization of SDM in the adjuvant interferon-α treatment decision was investigated in a subgroup of patients (n=108) using the nine-item Shared Decision Making Questionnaire (SDM-Q-9). More than 80% of the patients want to play an active role (autonomous or collaborative) in treatment decisions and only 17% want to delegate their decision to the doctor. We found a significant preference shift within a year in 43% of the patients, predominantly toward more active involvement. The results of the SDM-Q-9 indicate a moderate degree of perceived participation, with differing perceived implementation of the individual the SDM process steps. With the majority of melanoma patients preferring an active role in treatment decisions and improvable implementation of the SDM process steps in clinical practice, our findings support the relevance of SDM in dermato-oncology.