Patients' and clinicians' views on shared decision making in cancer care: a qualitative study of Aotearoa New Zealand patients' and clinicians' perspectives

Oncology stakeholders' view on shared decision making (SDM) in Aotearoa New Zealand is not well described in the literature. This study aimed to explore the perspectives of patients, clinicians and other cancer care stakeholders on shared decision making, and how and why shared decision making in cancer care can be viable and appropriate for patients and healthcare providers. Non-random, purposive sampling, combined with advertisement and snowball recruitment identified patient, whānau and healthcare provider participants for qualitative interviews. One-hour, semi-structured interviews were conducted to elicit perspectives on SDM. Data was analysed using Directed Content Analysis. Thirty-one participants were interviewed. SDM conceptualisations primarily concerned the sharing of information. Participants' stories highlighted patients' and whānau willingness to participate in making decisions about their care, to hold authority in this process, and to have their needs and preferences considered beyond the biomedical model. Patients and clinicians identified a range of factors moderating the extent of SDM, creating a gap between SDM expectations and practice. These data highlight the complexity of information needs in cancer care, and the discrepancy between patients' and their whānau and clinicians' views. This study increases our understanding of cancer stakeholders' expectations of SDM by highlighting various views on the meaning of SDM, informational needs and decision making engagement level. These findings can aid clinicians in creating space for patients to exercise their right to self-determination/rangatiratanga of health and wellbeing. Future work should explore approaches and implementations of SDM to facilitate an equitable experience of cancer care.