Tracing the dynamics of treatment decision-making: A qualitative study about older patients' treatment...

Treatment decisions are influenced by disease and patient related factors, yet little is known about how older patients evaluate these decisions after treatment. This study explores how older adults with cancer reflect on the treatment decision-making (TDM) process and whether they considered the treatment 'worth it', capturing perspectives before treatment and three months after TDM. The findings aim to inform person-centered treatment decision-making in geriatric oncology.

We conducted a qualitative study using semi-structured interviews at two timepoints: pre-treatment (after the decision but before treatment) and three months post-treatment. Patients were eligible for inclusion if they were over 70 years of age and diagnosed with a solid malignancy requiring a potentially surgical treatment decision. A thematic content analysis was performed.

We performed 16 semi-structured interviews among eight patients with a median age of 76.6 (range 71-81). Six themes were identified across the pre-treatment, treatment, and post-treatment phases, including navigation of personal and (social) contexts, alignment of treatment goals with personal priorities and values, the decision-making conversation, treatment-related aspects, post-treatment reflexivity on goals and preferences, and an overarching theme concerning communication and interaction with healthcare professionals.

How older patients reflected on the dynamic process of treatment decision-making and if they perceived the treatment to be worthwhile is a multidimensional process and influenced by context, values and priorities, the decision-making process, the treatment effects and communication. Reflections can be dominated by severe outcomes when a tipping point is reached where people can no longer return to their meaningful activities, underscoring the importance of explicitly discussing what matters to patients during TDM.