Use of time in shared decision-making: An explorative study

Time constraints are often reported as barrier to shared decision-making (SDM). Both cancer patients and physicians report needing time before, during, and/or after consultations to achieve patient involvement in treatment decisions. Perceived time for involving patients in decision-making may further be related to how much space participants have to contribute to the interaction. This study aimed to 1) investigate how time is used and talked about regarding cancer treatment decision-making in consultations in which SDM is appropriate, and 2) describe interactional space of consultations.

84 consultations between eye melanoma patients and their ocular oncologist in which final diagnosis and treatment options (surgery or radiation) were discussed, were audio recorded. We developed a quantitative coding system to rate how time is used and talked about during the consultations. We used items from the Unhurried Conversations Assessment Tool (UCAT) to assess observed interactional space. All analyses were performed in SPSS Statistics version 29.0.

About one-third of patients had heard their (expected) diagnosis in advance. Half or more patients asked questions regarding diagnosis or treatment options. In one-fifth of consultations, ocular oncologists asked questions to get to know the patient, and in most they explicitly stated that the patient had time to think about the decision. Overall, participants' pace during consultations was slow.

During consultations, patients use time to obtain information about diagnosis and treatment options. Patients do not routinely offer personal perspectives and ocular oncologists do not seek non-clinical patient-related information before a provisional or final treatment decision is made. Such information is however essential to integrate medical expertise with individual patients' situation. Especially when treatments markedly differ, physicians should discuss with patients how options fit patients' personal situation.