Decision Making about Localized Esophageal Cancer Treatment: An Observational Study on Variation in Clinicians' Communication Behavior.

Abstract

Background. For localized esophageal cancer, more than 1 curative treatment option is available. As these different options are associated with substantially different treatment outcomes, decision making can be complex. Moreover, treatment decision making for a patient involves multiple health care providers (HCPs) from different disciplines over time, who might have their own role and perspective on the decision-making process. This study aims to describe how HCPs communicate during treatment decision consultations with patients with localized esophageal cancer. Methods. Audio recordings of 20 preintervention scripted standardized patient assessments (SPAs) from the SOURCE trial were used. Using 2 highly similar cases, acted by a simulated patient, considerably reduced variation at patient level. Audio recordings were content coded using open coding and rated on the degree of patient involvement in decision making using the OPTION-12. Results. Radiation and surgical HCPs discussed 1 to 4 different treatment options, from a total of 5 different options observed over all consultations. They discussed 0 to 11 different side effects and complications, from a total of 28. While some HCPs explicitly presented a choice, many used various implicit forms of suggesting a choice and either implicitly or explicitly marked their own preferences for treatment. Consultations showed a mean OPTION-12 score of 40.11 (range 0-100). Conclusions. This study shows extensive practice variation in how and to what extent standardized patients with localized esophageal cancer were involved in decision making and in the number and type of treatment options and pros and cons that were presented to them. Implications. The findings suggest a need for mutual alignment within oncologic HCPs treating patients with esophageal cancer.

Highlights: Practice variation was found in how and to what extent health care providers involved standardized patients with localized esophageal cancer in decision making.Health care providers varied in the number and type of treatment options and pros and cons they presented.These findings suggest a need for multidisciplinary alignment.