Exploring Decision-Making and Patient Treatment Preferences and Concerns in Metastatic Breast Cancer: Findings from Medical Encounters in a Randomized Control Trial.

Background: Shared decision making (SDM) is critical for women with metastatic breast cancer (MBC), as they face complex treatment decisions involving trade-offs between efficacy, side effects, and quality of life. However, there is limited understanding of how these decision-making conversations unfold in clinical practice and how patient preferences are integrated. Methods: This qualitative study analyzed audio-recorded treatment decision-making encounters from a larger randomized controlled trial conducted between December 2018 and June 2022 at the University of Alabama at Birmingham. The trial evaluated the impact of a SDM intervention incorporating patient preferences into treatment plannings. Audio recordings were transcribed, time-stamped, and analyzed to determine total encounter time, speaker contributions, and encounter components. The qualitative data were also coded using NVivo to identify key themes related to patient preferences/concerns. Results: A total of 51 encounters were analyzed, with 51% of participants in the control arm and 49% in the intervention arm. Encounters ranged from 9 to 59 minutes, with an average length of 29 minutes. Oncologist speaking time averaged 18 minutes, while patient speaking time averaged 6 minutes. The majority of the time (62%) was devoted to treatment discussions, followed by relationship building (8%), results review (8%), and symptom review (7%). Prognostic discussions occurred in only 4% of encounter time. Patients expressed treatment concerns related to continuing daily activities, clinical trials, side effects, cost, and logistics, with no significant differences between intervention and control groups. Conclusions: While minor differences were observed between the control and intervention groups, overall, this study provides an in-depth exploration of the nature of decision-making encounters in MBC. Treatment decision-making encounters for women with MBC primarily focused on treatment options, with limited attention to prognosis and broader patient preferences. More comprehensive approaches are needed to effectively integrate patient values into clinical discussions. IRB Statement: This study was approved by the University of Alabama at Birmingham Institutional Review Board (IRB-300002283).