Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

A qualitative and quantitative exploration of family involvement in cancer consultation communication and decision-making (#93)

Rebekah C Laidsaar-Powell 1 , Phyllis N Butow 1 , Stella Bu 1 , Cathy Charles 2 , Amiram Gafni 2 , Jesse Jansen 3 4 , Kirsten J McCaffery 4 , Heather L Shepherd 1 , Wendy Lam 5 , Ilona Juraskova 1
  1. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia
  2. Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
  3. Department of Cancer Medicine, The University of Sydney, Sydney, NSW, Australia
  4. Screening and Diagnostic Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
  5. Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong

Aims: Despite high rates of family attendance within cancer consultations, relatively little is known about doctor-patient-family (triadic) communication and decision-making.  This mixed methods study aimed to explore the attitudes and behaviours of patients, family members, and health professionals regarding family involvement in communication and decision making. It also aimed to elucidate strategies to optimise triadic communication.

Methods: Attitudes and behaviours of patients, family members, and health professionals were explored through qualitative interviews and quantitative analyses of audio-taped oncology consultations. Semi-structured interviews were conducted with cancer patients/survivors (n=30), family members (e.g. spouse, adult child; n=34), oncology nurses (n=10), and oncology doctors (n=11). Additionally, a newly developed comprehensive triadic interaction analysis coding frame was applied to n=100 audio-taped and transcribed initial oncology consultations, collected from two previous studies.

Results: Interviews with patients, family members, and health professionals revealed facilitators and barriers to, and challenges and benefits of, family involvement, and the nature of family involvement in treatment decision-making. Family members were often a part of every stage of the decision-making process, however their involvement levels appeared to be dynamic, with active family involvement during the information exchange stage, whilst family members played a more supportive role during the deliberation and decision-making stages. Extent of family involvement appeared to be influenced by a number of demographic, relationship, and clinical factors. Results from the interaction analysis coding system will also be presented, including patient, family, and oncologist behaviours and any relationship between family involvement levels and patient outcomes.

Conclusions: This study improves our understanding of patient, family, and health professional experiences of, and actual behaviours within, triadic cancer consultations. These qualitative and quantitative results have the potential to improve cancer consultations through the identification of stakeholder’s preferences, attitudes, and behaviours.  Results will inform a conceptual framework of triadic decision-making and guidelines for health professionals.