Shared decision-making for early-stage breast cancer treatment: An evolutionary concept analysis

The lack of a clear and unified definition of shared decision-making (SDM) may hinder its effective application in oncology care. This study aims to clarify the concept of SDM specifically in the context of early-stage breast cancer treatment through an evolutionary concept analysis.

A systematic search was conducted across PubMed, CINAHL, PsycINFO, Cochrane, and EMBASE databases for articles published from January 2015 to December 2024. Using keywords "shared decision-making" and "breast cancer," relevant studies were identified, and key attributes of SDM were extracted and synthesized. Sixteen studies met the inclusion criteria.

SDM for early-stage breast cancer treatment was characterized by 10 attributes spanning three levels: 1) Patient perspective: involvement in decision-making, values and preferences regarding treatment options, and deliberative thinking to achieve choice certainty; 2) Healthcare professional perspective: provision of individualized information, psychological support, consultation focused on patients' best interests, collaborative partnerships with patients, coordinated care delivery, and promotion of person-centered, informed choices; 3) Healthcare system level: fostering a patient-centered healthcare culture.

These findings provide a comprehensive conceptual framework to guide the development of detailed SDM guidelines tailored for early-stage breast cancer patients. Enhanced understanding of SDM can support nurses and healthcare professionals in facilitating collaborative and optimal decision-making processes within oncology care. Furthermore, this study lays the groundwork for developing measurement tools and disease-specific interventions to advance SDM implementation in early-stage breast cancer treatment.

PROSPERO (CRD42024587218).