Who decides? Shared decision-making among colorectal cancer surgery patients in China
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ORIGINAL ARTICLE
Who decides? Shared decision-making among colorectal cancer surgery patients in China Huiwen Zhai 1,2 & Christopher Lavender 1 & Cong Li 3 & Haotan Wu 2 & Ni Gong 4 & Yu Cheng 2,5 Received: 6 November 2019 / Accepted: 27 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Patient-centered care (PCC) and shared decision-making (SDM) is advised within the English medical literature for its positive impact. The benefits of such approaches are said to foster increased trust, patient decision satisfaction, and even better outcomes. Looking at a Chinese cancer hospital, this research sought to understand how surgical decision-making was made among colorectal cancer patients. Methods Observations (n = 36) and semi-structured interviews (n = 24) were conducted with patients and family members. Results In the observations, 69.4% of the participating families made the decision to undergo surgery at the end of the consultation. In the interviews, three main themes emerged in regard to the characteristics in the family decision-making model, and they included three structural elements: the patient’s sick role, family functional structure, and control of information. Conclusion This study showed that the Chinese decision-making model is different from the western SDM model. In the Chinese context, family members dominated the decision-making process which raised concerns around informed consent. This may benefit patients insofar as receiving timely treatment in the short term but at the same time may be at the expense of limiting patient’s autonomy. The promotion of a new model or a model encompassing family-centered care values may be more appropriate in clinical practice in China that can address the issues around informed consent. Keywords Cultural issues . Shared decision-making . Family . China
Introduction Current cancer statistics estimate there will be 18.1 million new cancer cases worldwide for 36 cancers in 185 countries [1]. Since the 1980s, there has been a shift towards patientcentered care (PCC) and shared decision-making (SDM) in the English medical literature and western clinical practice. This was in response to criticisms of the traditional doctorpatient relationship being too paternalistic and one-directional [2, 3].
* Yu Cheng [email protected] 1
2
Office of Research Management and Education Administration, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou 510275, Guangdong, China
Definitions of SDM advocate more patient involvement and transparency in treatment and care. One definition of SDM is “a process whereby clinicians collaboratively help patients to reach evidence-informed and value-congruent medical decisions” [4]. In the SDM model, patients are encouraged to build a consensus about the preferred treatment [5]. There is also overlap wi
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