Understanding patient's experiences and their involvement in treatment decision-making for early-stage non-small cell lung cancer

Abstract

Surgical treatment remains the gold standard in early-stage non-small cell lung cancer. It offers overall survival benefits, either on its own or as a part of multimodality treatment. Stereotactic ablative radiotherapy is an alternative option for those patients deemed unfit for or declined surgery. Managing early-stage non-small cell lung cancer requires increasingly complex decision-making by healthcare professionals. In this setting, it is important to have shared decision making with the patient to ensure they understand the risks, side effects and treatment options. However, there are limited studies addressing healthcare professionals' perspectives on treatment decision-making and patients' experiences within this treatment decision-making process for early-stage non-small cell lung cancer. This study aimed to explore patients' experiences and involvement in treatment decision-making for early-stage non-small cell lung cancer using a qualitative pragmatic approach. Twenty-four participants, including patients and their healthcare professionals, were recruited using purposive sampling. The multi-source data collection started from patients' first consultation with surgeons or oncologists to discuss treatment options for early-stage non-small cell lung cancer and three months after treatment. Participants were recruited from two centres- surgery and oncology. Data collection included audio recordings of the first consultation and in-depth semi-structured interviews with patients and their healthcare professionals. Thematic analysis methods were used to analyse the data. The synthesis of the key findings is discussed in three overarching themes. These are 'Dilemmas in treatment options and treatment decision-making process', 'Information sources and systemic barriers to treatment decision-making', and 'Deliberation and strategies to improve treatment decision-making'. The study shows the complexity of treatment decision-making in early-stage non-small cell lung cancer. Currently, shared decision making is not often used in practice. Instead, consultations focused on informing MDT recommendations, gathering information, and consenting to the procedure. Patients' preferences, values, alternative options, and long-term treatment outcomes were not explicitly discussed. Patients preferred professionals to facilitate treatment decisions by presenting the information clearly and comprehensively. Findings highlight the need to adopt a patient-centred approach, provide emotional support throughout the treatment process, and acknowledge their values in treatment decision-making.

Date of Award	1 Aug 2024
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Sorrel Burden (Supervisor) & Janelle Yorke (Supervisor)