Oncologist‐patient‐caregiver decision‐making discussions in the context of advanced cancer in an Asian setting

Health Expectations. 2020;23(1):220-228 DOI 10.1111/hex.12994


Journal Homepage

Journal Title: Health Expectations

ISSN: 1369-6513 (Print); 1369-7625 (Online)

Publisher: Wiley

LCC Subject Category: Medicine: Medicine (General) | Medicine: Public aspects of medicine

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML



Chetna Malhotra (Lien Centre for Palliative Care Duke‐NUS Medical School Singapore Singapore)

Ravindran Kanesvaran (National Cancer Centre Singapore Singapore Singapore)

Nesaretnam Barr Kumarakulasinghe (National University Cancer Institute Singapore (NCIS)National University Health System Singapore Singapore)

Sing‐Huang Tan (OncoCare Cancer Centre Gleneagles Medical Centre Singapore Singapore)

Ling Xiang (Lien Centre for Palliative Care Duke‐NUS Medical School Singapore Singapore)

James A. Tulsky (Dana‐Farber Cancer Institute Boston MA USA)

Kathryn I. Pollak (Cancer Control and Population SciencesDuke University Durham NC USA)


Double blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 13 weeks


Abstract | Full Text

Abstract Objective Patient involvement in treatment decisions is recommended in clinician‐patient encounters. Little is known about how oncologists engage patients in shared decision making in non‐Western countries. We assessed the prevalence of shared decision making among Singaporean oncologists and analysed how they discussed prognosis. Methods We audio‐recorded 100 consultations between advanced cancer patients and their oncologists. We developed a coding system to assess oncologist encouragement of patient participation in decision making and disclosure of an explicit prognosis. We assessed patient and oncologist characteristics that predicted these behaviours. Results Forty‐one consultations involved treatment discussions. Oncologists almost always listed more than one treatment option (90%). They also checked patient understanding (34%), discussed pros and cons (34%) and addressed uncertainty (29%). Oncologists discussed prognosis mostly qualitatively (34%) rather than explicitly (17%). They were more likely to give an explicit prognosis when patients/caregivers asked questions related to prognosis. Conclusion Oncologists in our sample engaged their patients in decision making. They have areas in which they can improve to involve patients at a deeper level to ensure shared decision making. Findings will be used to develop an intervention targeting oncologists and patients to promote patient involvement in decision making.