The duality of option-listing in cancer care.
Alexandra Tate, B J Rimel
PMID 31383562WHAT IT FOUND
In initial cancer treatment, oncologists list options but steer patients toward their preferred choice.
When standard treatments fail, they present remaining options equally, often signaling that a cure is unlikely.
Key findings
01Option-listing occurred in only 10% of the 68 treatment recommendations identified in the consultations.
02When discussing initial treatment, oncologists explicitly recommended one option or framed others as less desirable, guiding the patient toward a specific path.
03When existing treatment failed, oncologists withheld preference and emphasized drawbacks of all remaining options, potentially signaling diminishing hope.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a pilot study with a small number of option-listing events (n=7), so the findings are suggestive rather than definitive. The sample was limited to gynecologic and urologic oncology at two hospitals, which may not reflect practice in other specialties or settings. The interpretation that withholding preference signals bad news is a theoretical inference by the authors, not a direct measure of patient understanding or outcome.
Declared interests
The paper reports support from the National Institutes of Health (N.I.H., Extramural). No other conflicts of interest are declared in the provided text.
The easy way to misread this
Do not conclude that shared decision-making is rare in oncology. The study only looked at how options were verbally listed in transcripts; it did not measure patient understanding, the quality of the entire consultation, or whether choice was effectively communicated through other means.