Decision-making under clinical uncertainty: An in-depth examination of provider perspectives on adjuvant chemotherapy for stage II colon cancer.
Rachel C Shelton, Laura E Brotzman, Danielle M Crookes and 2 others
PMID 30262401WHAT IT FOUND
Oncologists and surgeons often assumed less educated patients did not want to participate in chemotherapy decisions.
Many used words rather than numbers to explain the uncertain benefits of treatment. Guidelines for discussing these risks were inconsistently followed.
Key findings
01Providers frequently assumed that patients with lower education levels were less likely to want information about prognosis or to participate in decision-making, without objectively assessing the patient's preferences.
02Most providers reported using words rather than numbers to communicate the uncertain benefits and risks of adjuvant chemotherapy, believing patients expect providers to determine the best course of action.
03While aware of clinical guidelines for discussing chemotherapy options, providers varied greatly in how they applied them, with some surgeons explicitly refusing to discuss uncertainty and stating treatment was not necessary.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study focused exclusively on provider perspectives and did not include patient interviews, so it cannot confirm whether patients actually shared the providers' assumptions about their desire for involvement. Participants were recruited from urban academic centers, which may not reflect the communication practices of community or rural healthcare providers. The sample was heavily weighted toward oncologists and surgeons, with fewer nurses and other staff, limiting the generalizability of findings to the broader care team.
Declared interests
The study was supported by the National Institutes of Health (N.I.H., Extramural) and non-U.S. government research support. No specific conflicts of interest involving commercial entities were reported in the provided text.
The easy way to misread this
Do not assume that providers are consistently following shared decision-making guidelines. The study found significant variation, with some surgeons actively avoiding discussions about treatment uncertainty. Also, be cautious of assuming patient preferences based on education level; providers in this study frequently made incorrect assumptions about which patients wanted to be involved.