Between May 2020 and June 2020, surveys were administered to 53 patients with bladder cancer (48% female, mean age 68 years) and 23 health care providers (mean age 38 years, 68% nurse/nurse navigators), as part of in-clinic and virtual collaborative patient education sessions across five US-based practices. Surveys were designed to assess perceptions, preferences, and experiences with regard to shared decision-making during bladder cancer care.
Survey findings indicated key alignments and discordances in patient’s reported experience and healthcare provider’s perceptions of the use of shared decision-making in bladder cancer care. Healthcare providers and patients identified the same top two patient goals for bladder cancer care: 1) preventing progression/recurrence (61% patients, 48% health care providers) and 2) maintaining quality of life (35% patients, 78% healthcare providers):
When asked to identify patients' top challenges for patients with bladder cancer, both patients and healthcare providers indicated post-treatment aspects as the top challenge, though patients indicated managing side effects/serious worry about side effects from treatment as the top challenge (22%), whereas healthcare providers were split evenly between managing side effects from treatment (26%) and managing life changes as a result of urinary diversion (26%):
Healthcare providers overestimated the effect that fatigue and worry had on patient’s capacity for shared decision-making: only 9% of patients indicated worry or fatigue as a barrier to shared decision-making, but 65% of healthcare providers indicated this as a likely barrier:
Furthermore, the patient experience of shared decision-making differed from healthcare providers' perception of shared decision-making. For some aspects of shared decision-making, such as explaining different treatment options, explaining pros/cons of treatment options, and overall involvement in treatment decisions, fewer healthcare providers indicated that these aspects of shared decision-making always or usually occurred as compared to patients.
Dr. Chamie concluded his presentation with the following take-home points:
- Shared decision-making is essential for creating individualized treatment plans that align with specific patient needs and goals
- There are significant discordances between healthcare providers' perceptions and patient-reported goals, challenges, and barriers to treatment decision-making and care for bladder cancer
- Open discussion between patients and their care teams significantly improves patients understanding of new treatment options, treatment side effects, and management of treatment-related side effects
- Effective shared decision-making encourages patients to take an active role in their bladder cancer care
- These data highlight essential alignments and discordances between patients and their care teams regarding bladder cancer and shared decision-making, which may inform future educational initiatives
Presented by: Karim Chamie, MD, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
Written by: Zachary Klaassen, MD, MSc, Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Augusta, Georgia, Twitter: @zklaassen_md during the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (#GU21), February 11th-February 13th, 2021