Decision Making about Localized Esophageal Cancer Treatment: An Observational Study on Variation in Clinicians'...

Area of Science:

• Oncology
• Health Services Research
• Medical Communication

Background:

• Localized esophageal cancer offers multiple curative treatment options, leading to complex decision-making.
• Treatment decisions involve a multidisciplinary team of healthcare providers (HCPs) with diverse perspectives.
• Understanding HCP communication during these consultations is crucial for improving patient care.

Purpose of the Study:

• To describe how healthcare providers communicate during treatment decision consultations for localized esophageal cancer patients.
• To assess the extent of patient involvement in decision-making processes.
• To identify variations in the presentation of treatment options and their associated risks and benefits.

Main Methods:

• Analysis of 20 audio-recorded, scripted standardized patient assessments (SPAs) from the SOURCE trial.
• Content coding of recordings using open coding methodology.
• Measurement of patient involvement using the OPTION-12 tool.

Main Results:

• Healthcare providers discussed a limited range of treatment options (1-4 out of 5) and side effects (0-11 out of 28).
• Varied approaches were observed in presenting choices, with many providers implicitly or explicitly stating preferences.
• The mean OPTION-12 score was 40.11, indicating substantial variation in patient involvement.

Conclusions:

• Significant practice variation exists in patient involvement and the information provided regarding treatment options for localized esophageal cancer.
• The number and type of treatment options, along with their pros and cons, varied considerably among providers.
• Findings highlight the need for enhanced multidisciplinary alignment among oncologic healthcare providers.