Treatment decision-making during outpatient clinic visit of patients with esophagogastric cancer. The perspectives of clinicians and patients, a mixed method, multiple case study
Luijten, Josianne C.H.B.M.; Brom, Linda; Vissers, Pauline A.J.; van de Wouw, Yes A.J.; Warmerdam, Fabienne A.R.M.; Heisterkamp, Joos; Mook, Stella; Oulad Hadj, Jamal; van Det, Marc J.; Timmermans, Liesbeth; Hulshof, Maarten C.C.M.; van Laarhoven, Hanneke W.M.; Rosman, Camiel; Siersema, Peter D.; Westerman, Marjan J.; Verhoeven, Rob H.A.; Nieuwenhuijzen, Grard A.P.
(2022) Cancer Medicine, volume 11, issue 12, pp. 2427 - 2444
(Article)
Abstract
Background: The probability of undergoing treatment with curative intent according to the hospital of diagnosis varies for esophagogastric cancer in the Netherlands. Little is known about the factors contributing to this variation. This study aimed to improve the understanding of the differences between the multidisciplinary team meeting treatment proposal and
... read more
the treatment that was actually carried out and to qualitatively investigate the differences in treatment decision-making after the multidisciplinary team meeting treatment proposal between hospitals. Methods: To gain an in-depth understanding of treatment decision-making, quantitative data (i.e., multidisciplinary team meeting proposal and treatment that was carried out) were collected from the Netherlands Cancer Registry. Changes in the multidisciplinary team meeting proposal and applied treatment comprised changes in the type of treatment option (i.e., curative or palliative, or no change) and were calculated according to the multivariable multilevel probability of undergoing treatment with curative intent (low, middle, and high). Qualitative data were collected from eight hospitals, including observations of 26 outpatient clinic consultations, 30 in-depth interviews with clinicians, seven focus groups with clinicians, and three focus groups with patients. Clinicians and patients' perspectives were assessed using thematic content analysis. Results: The multidisciplinary team meeting proposal and applied treatment were concordant in 97% of the cases. Clinicians' implementation of treatment decision-making in clinical practice varied, which was mentioned by the clinicians to be due to the clinician's personality and values. Differences between clinicians consisted of discussing all treatment options versus only the best fitting treatment option and the extent of discussing the benefits and harms. Most patients aimed to undergo curative treatment regardless of the consequences, since they believed this could prolong their life. Conclusion: Since changes in the multidisciplinary team meeting-proposed treatment and actual treatment were rarely observed, this study emphasizes the importance of an adequately formulated multidisciplinary team meeting proposal.
show less
Download/Full Text
Keywords: clinicians' perspectives, esophageal and gastric cancer, multidisciplinary team meeting, patients' perspectives, treatment decision-making, Decision Making, Esophageal Neoplasms/diagnosis, Humans, Ambulatory Care Facilities, Research Design, Stomach Neoplasms/diagnosis, Oncology, Radiology Nuclear Medicine and imaging, Cancer Research, Research Support, Non-U.S. Gov't, Journal Article
ISSN: 2045-7634
Publisher: John Wiley and Sons Ltd
Note: Funding Information: PS: Research support or funding: EndoStim, Pentax, Norgine, Motus GI and The Enose company Advisory Board: Motus GIE; HvL: Consultant or advisory role: BMS, Lilly, MSD, Nordic Pharma, Servier, Research funding and/or medication supply: Bayer, BMS, Celgene, Janssen, Lilly, Nordic Pharma, Philips, Roche, Servier; RV: received research grants from Roche and Bristol‐Myers Squibb; For the remaining authors no conflict of interest was declared. Funding Information: Ethics approval was not required according to the Medical Research Ethics Committees United of the Netherlands (number: W.18.166). All participating hospitals approved this study. All quantitative data collected by the NCR were de‐identified and coded. Written informed consent was obtained from all participants prior to the interview or start of the patient focus groups. Privacy and confidentiality were protected through pseudonymization. The transcripts and summaries will be stored pseudonymized for a minimum of 10 years, on the secured network of IKNL, to which only the core research team members have access. This study was funded by the Dutch Cancer Society (project number: 10895). Funding Information: The authors thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the NCR. This research was not preregistered. Data and methods can be requested at the Netherlands Comprehensive Cancer Organization (IKNL). The authors would like to thank the clinicians and patients for their time and openness during the interviews and focus groups. This study was funded by a grant from the Dutch Cancer Society (project number 10895). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. © 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
(Peer reviewed)
