26  A rapid realist review: how shared decision-making approaches and patient aids influence treatment decisions for patients with advanced (non-curative) cancer?. (30th January 2023)

• Record Type: Journal Article
• Authors: Holland-Hart, Daniella; Edwards, Michelle; Mann, Mala; Longo, Mirella; Byrne, Anthony; Nelson, Annmarie
• Is Part Of: BMJ supportive & palliative care. Volume 13(2023)Supplement 1
• Page Start: A11
• Page End: A11
• Publication Date: 2023-01-30
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/spcare-2023-MCRC.25
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Introduction: Patients with advanced non-curative cancer are typically offered active palliative treatments (Chemotherapy, radiotherapy and immunotherapy). However, evidence suggests that when active treatment is used near the end of life it can result in worse quality of life, particularly those facing 30-day mortality. Patients' preferences should therefore be carefully integrated into these treatment decisions. Aims: We aimed to identify and explain contextual factors and intervention mechanisms that influence patients experiences in making decisions about palliative treatments and supportive care, when supported with patient aids and shared decision-making approaches. Methods: A realist review method (co-produced with public and clinical stakeholders) was used to search, appraise, synthesise and analyse the current research evidence. A theoretical model was produced to explain connections between contextual factors, intervention mechanisms and patient experience outcomes. Results: We included 41 papers in the review and produced a theoretical model which explains how patient (and family) experiences, clinician support, access to palliative care and communication can influence patients' engagement and satisfaction with decisions. It outlines how mechanisms such as enabling preparation for decision-making, providing accessible information, increased palliative care involvement, and supporting opportunities for patients to reflect on preferences and prior experiences of treatment decision-making. Conclusions: In order to improve patient's experiences of making difficult decisions about treatments for advanced cancer and supportive care they need time to engage with key information, revisit and re-evaluate information and decision-making before and during consultations. Multi-component, multi-format interventions that include additional input from palliative care specialists may prove most effective. Impact: These key contexts and intervention mechanisms identified can be incorporated in the design of a complex intervention aimed at improving treatment decision-making for patients with advanced non-curative cancer.