Dr Thomas LeBlanc on the Importance of Shared Decision Making in Cancer Care

Thomas LeBlanc, MD, of the Duke Cancer Institute, addresses the importance of adding a palliative care specialist to the cancer care team.

Transcript

What is the importance of involving carious team members in care for patients with blood cancers to help improve their patient experience?

Shared decision making is one of the biggest challenges we face in modern cancer care today. Although the Institute of Medicine, now known as the National Academy of Medicine, has been saying we should be doing shared decision making for about a decade or more now, it’s something that most of us struggle with in practice and most of us have never formally been trained in how to do it. It’s like the old medical model of see one, do one, teach one, and a lot of us really fumble through this doing it in a way that ends up being more of a superficial discussion about risks and benefits of treatment rather than a more substantive discussion about what’s important to that person.

So, the palliative care team, which includes folks who have specialized training in difficult communication and listening to people’s goals, values, and preferences really can be helpful in facilitating shared decision making in cancer care, especially in those situations where we’re quite uncertain about what the outcome is going to be, maybe the prognosis looks statistically poor but we’re still hoping there could be a good outcome or maybe a risky treatment like stem cell transplantation. This is when we really need to elicit people’s goals, values, and preferences and then tell them more about the risks and benefits of treatment but to map those up to what is important to them and help figure out together what the right treatment may be.

We’ve been finding in research presented here at ASH by my colleague Dr. El-Jawahri at Mass General and some other recent studies over recent years that many patients with cancer actually don’t want to be the primary decision maker about their treatment and yet most physicians don’t feel comfortable about making treatment recommendations and we want to just tell people here are the risks and benefits, here are the options, what do you want to do? Make a choice. That’s actually not how many people want to make decisions. We really have to flip this paradigm on it’s head and get more comfortable with diagnosing people’s preferences, which is really a foreign concept for many of us.

How do we actually ask questions that elicit patient’s preferences, goals, and values and then plug those in with what we know about the disease that we’re experts on, what we know about the treatment and the likely outcomes that we can really attest to with our medical expertise and help them figure out how that maps up with what’s actually important to them as people. It’s incredibly challenging and certainly easier to talk about than to actually do well, but it’s an area that we need to focus on over in the next several years to improve patient centered care and truly personalize care where the treatment that’s recommended and prescribed really matches up with the goals, values, and preferences of that person.