ASCO GU 2021: Alignment and Discordances in Perceptions and Experiences of Shared Decision Making Among Bladder Cancer Patients and Their Care Team

(UroToday.com) Shared decision-making regarding cancer treatment is critical. In previous PRIME educational programs involving patients with bladder cancer and their care teams, effective shared decision-making was found to be integral to the development of treatment plans that reflected patient preferences and treatment goals. However, oncology care teams face complex barriers that impede their ability to personalize bladder cancer therapy for each patient. PRIME conducted a Collaborative Learning Program in five US healthcare systems to support communication and shared decision-making between patients with bladder cancer and their urology/medical oncology teams to improve outcomes and quality of life for these patients. At the 2021 American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium, Dr. Karim Chamie and colleagues presented results of their study assessing alignment and discordances on aspects of shared decision-making among bladder cancer patients and their urology and oncology teams.

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):

top 2 patient reported goals vs hcp perceived patient goals

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%):

top 2 patient reported challenges vs hcp perceived top patient challenges

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:

actual top 2 patient barriers to sdm vs hcp perceived patient barriers to sdm

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