- Title
- Working towards patient-centred decision making in cancer care
- Creator
- Herrmann, Anne
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2018
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Many cancer patients have to choose between a variety of treatment options. Optimal cancer care should involve patients in their treatment decisions, to the extent they desire. It should align with patients’ needs and preferences. Patient-centred decision making constitutes a core component of a high-quality healthcare system. However, it is not always delivered to cancer patients. This thesis examines cancer patients’ preferences for and experiences with making treatment decisions. It consists of six papers, an introduction and a discussion. The findings of this thesis make an important contribution to increasing our understanding of how treatment decision making could be improved in clinical practice. The introduction provides an overview of the literature on patient-centred decision making and its relevance to cancer care in Australia and worldwide. The six manuscripts included in this thesis report on the findings of two quantitative and one qualitative study of cancer patients and their support persons who were recruited from medical and radiation oncology waiting rooms of treatment centres across New South Wales and Victoria. The thesis aims to: 1. Examine whether not asking cancer patients about their decision-making preferences is associated with their care experience (Paper One). ; 2. Explore in-depth how cancer patients made a difficult treatment decision (Paper Two), and which strategies could be used to assist with this process (Paper Three). ; 3. Examine cancer patients’ (Paper Four) and their support persons’ (Paper Five) preferences for the number and length of consultations and the format of information provided when making a cancer treatment decision. ; 4. Review the literature on decision aids to examine where research effort has been directed to over time, and where the focus of future studies should lie (Paper Six). The thesis concludes with a discussion summarising the key findings and outlining the potential implications for future research and clinical practice. The strengths of this thesis include using both qualitative and quantitative methods to assess cancer patients’ decision-making preferences and experiences. Methodologically robust and innovative approaches were employed to collect and analyse data from heterogeneous samples of Australian cancer patients and their support persons. Following a mixed-methods approach, the qualitative data was used to develop strategies to improve patient-centred decision making in cancer care. The generalisability of these strategies was examined with the help of a larger, more heterogeneous sample of cancer patients and their support persons using a cross-sectional design. The integration of this data informed the development of an intervention which is described in the discussion section of this thesis. The thesis limitations include the restriction to English-speaking cancer patients, over-representation of female breast cancer patients and the use of a cross-sectional design. Recommendations for how future research could extend on the thesis findings are provided, including suggestions for a cluster randomised controlled trial that should investigate the impact of different consultation styles on patient outcomes.
- Subject
- patient-centred care; shared decision making; decision aids; cancer care; mixed methods; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1389079
- Identifier
- uon:32847
- Rights
- Copyright 2018 Anne Herrmann
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 18 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 201 KB | Adobe Acrobat PDF | View Details Download |