Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know?

Learning Objectives After completing this course, the reader will be able to: Outline the five steps that comprise shared decision making. Identify specific tactics that can be used to engage a patient in a shared decision making process. This article is available for continuing medical education credit at CME.TheOncologist.com Background. There is growing interest by patients, policy makers, and clinicians in shared decision making (SDM) as a means to involve patients in health decisions and translate evidence into clinical practice. However, few clinicians feel optimally trained to implement SDM in practice, and many patients report that they are less involved than they desire to be in their cancer care decisions. SDM might help address the wide practice variation reported for many preference‐sensitive decisions by incorporating patient preferences into decision discussions. Methods. This paper provides a perspective on how to incorporate SDM into routine oncology practice to facilitate patient‐centered communication and promote effective treatment decisions. Oncology practice is uniquely positioned to lead the adoption of SDM because of the vast number of preference‐sensitive decisions in which SDM can enhance the clinical encounter. Results. Clinicians can facilitate cancer decision making by: (a) determining the situations in which SDM is critical; (b) acknowledging the decision to a patient; (c) describing the available options, including the risks, benefits, and uncertainty associated with options; (d) eliciting patients' preferences; and (e) agreeing on a plan for the next steps in the decision‐making process. Conclusion. Given recent policy movements toward incorporating SDM and translating evidence into routine clinical practice, oncologists are likely to continue expanding their use of SDM and will have to confront the challenges of incorporating SDM into their clinical workflow. More research is needed to explore ways to overcome these challenges such that both quality evidence and patient preferences are appropriately translated and incorporated into oncology care decisions. 摘要 背景 分享决策制定（ SDM ）日益得到患者、政策制定者、临床医生的关注，逐渐成为一种用于健康决策以及将证据转译成为临床实践的手段。然而，仅极少数临床医生认为其得到理想的培训来帮助他们在临床实践中实施 SDM ，很多患者则报告指出，他们参与癌症治疗决策的程度低于期望值。很多情况下临床讨论中充分考虑到患者意愿并制定出意愿敏感性决策，但临床实践往往千差万别， SDM 可能有助于应对这种现象。 方法 本文将探索如何将 SDM 融入肿瘤学常规实践中，从而促进以患者为中心的交流和沟通，推动有效的治疗决策制定。肿瘤学实践在引导 SDM 应用方面具有得天独厚的优势，这是因为其拥有大量的意愿敏感性决策， SDM 能够在这样的决策中增强临床互动。 结果 临床医生可通过以下方式推进癌症决策制定：(a)明确何种情况下 SDM 是至关重要的；(b)将决策告知