3714 - How do Patients and Physicians Perceive Shared Decision-Making in Radiation Oncology? Insights from an Institutional Survey and Literature Review
Presenter(s)
S. Rana1,2, S. Shao3, M. Zaguia1,2, E. Babadagli4,5, J. Meng4,5, and R. Samant4,5; 1University of Ottawa, Ottawa, ON, Canada, 2The Ottawa Hospital, Ottawa, ON, Canada, 3Western University, London, ON, Canada, 4The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada, 5Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
Purpose/Objective(s): Cancer treatment decisions are often complex and overwhelming for patients. Shared decision-making (SDM) plays a pivotal role in enhancing patient care and improving healthcare outcomes in radiation oncology. We hypothesize that SDM is underutilized and undervalued in radiation oncology, despite its recognized benefits for patient satisfaction. This study examines SDM in radiation oncology by evaluating perspectives within one institution and comparing them to existing literature.
Materials/Methods: Radiation oncology physicians and their patients were surveyed to assess perspectives on SDM. Thirty-two physicians (residents, fellows, and faculty) and 199 patients participated in respective ethics-approved surveys, conducted from 2018-2020. To review literature, a comprehensive search of Medline, PubMed, and EMBASE was conducted for articles published up to February 2025. Following a two-stage screening process of titles, abstracts, and full texts, a total of 32 studies met the inclusion criteria. Data extraction focused on key endpoints, including perceptions of SDM utility, and factors that facilitate or hinder its implementation. A thematic analysis was then performed to identify recurring patterns.
Results: The vast majority of patients (93%) “agreed” or “strongly agreed” that they felt included in the decision-making process. However, patients expressed a desire for additional time to discuss their specific clinical circumstances. Most staff (91%) felt that patients wanted to be involved in treatment decisions—53% very much and 38% somewhat—closely aligning with the 94% who reported actually involving patients in SDM. Notably, while 95% of faculty physicians felt that patients should be involved in treatment decisions “very much,” only 38% of residents shared this view. Across literature, patients generally associated SDM with increased patient satisfaction, improved treatment adherence, and reduced decisional conflict. However, a recurring theme was the perceived gap between patients' desire for SDM and their actual involvement. While staff attitudes toward SDM were largely positive, patient motivation for SDM and perceived clinical improvement were key facilitators in choosing to employ SDM. With respect to limitations, measurement tools for SDM may not be completely accurate, as experiencing a treatment choice does not necessarily equate to SDM.
Conclusion: SDM is recognized as beneficial in radiation oncology, but a gap remains between patients' and physicians’ desire for its involvement and its actual application in practice. To bridge this divide, staff—particularly trainees—must be better informed of patients' SDM preferences. Addressing barriers such as time constraints, patient education, and standardized SDM implementation could enhance its integration into clinical practice.