Patients and doctors may bring differing priorities, expectations and goals to a medical consultation.
To determine the frequency with which decision making factors, identified by older people with cancer and healthcare professionals, are discussed during oncology consultations.
Patients aged 70 or over were recruited from the institution's oncology clinics. Eligible patients were English speaking and attending an initial consultation or following a re-staging procedure to assess treatment response. Consultations were audio-recorded and transcribed. A content analysis was conducted using a coding scheme based on factors influencing cancer treatment decisions by healthcare professionals and older people, identified from previous qualitative research.
11 consultations with patients aged 70 to 84 years were analysed. Decision making factors reported as important by clinicians and patients, including age, and treatment benefits and risks were discussed in the majority of consultations. Of decision making factors reported as important by clinicians only, comorbidities, medication use and social support were routinely discussed (3.8, 3.6, and 2.6 times per consultation), compared with cognition and frailty (0.1 and 0.2 times per consultation). Decision making factors identified only by patients were less frequently addressed, with family views and quality of life infrequently discussed (0.6 and 0.9 times per consultation), although physician opinions (1.8 times per consultation) were expressed.
Consultations were medically focused, with clinicians' decision making factors more likely to be addressed than items considered important by patients.