Factors impacting informed decision-making for patients with pancreatic cancer: a qualitative study

Informed decision-making is an essential component of shared decision-making between patients and their cancer teams that promotes patient comprehension of their disease and available treatment options. The complex nature of multidisciplinary treatment for pancreatic cancer (PC) presents unique challenges for informed decision-making, for which barriers and facilitators are poorly understood.

In this qualitative study, semi-structured interviews were conducted with PC patients seeking treatment at a Midwestern, high-volume, academic medical center to examine various aspects of informed decision-making, including patients' understanding of treatment options, challenges in obtaining information, and how a decision aid may improve decision-making. Purposive sampling was used for recruitment and continued until thematic saturation was achieved. All interviews were audio-recorded, transcribed, and coded by the research team. Qualitative analysis was completed using an integrative approach involving both inductive and deductive methods.

Across 20 PC patients interviewed, the median age was 67 years, with 30% having metastatic disease (n = 6). Most patients reported having a knowledge gap about PC treatment options, requiring them to explore multiple resources to support their treatment decision-making. Furthermore, most interviewees noted that additional information in the form of a decision aid could be helpful in their decision-making process, particularly in understanding the advantages and disadvantages of treatment options, but also in introducing supportive care resources and improving their understanding of palliative care. However, concerns regarding the potential for providing too much information at once were common and perceived as potentially overwhelming.

This qualitative study highlights the challenges that PC patients face in making informed treatment decisions and, therefore, in engaging in shared decision-making. Further research on patient-centered strategies, such as decision aids, is needed to improve the quality of both shared and informed decision-making.