Defer, Share, or Drive the Decision: Empowering Patients with Varied Preferences to Engage in Decision-making (an Analysis from Alliance A231701CD)

To understand how breast cancer patients experience the surgical decision process and identify strategies surgeons can employ to empower patients to engage in decision-making. Patient engagement in decision-making is associated with improved patient outcomes. Although, some patients prefer that their healthcare provider drive the decision, the benefits of engaging in decision-making hold true even for patients who prefer to defer to their provider. We performed semi-structured interviews with patients that experienced low engagement in clinical trial A231701CD (n=30). We used qualitative content analysis to analyze data and organize it into overarching themes that represent experiences with decision-making. Patients could be grouped based on their experiences with the decision process into those that wanted to defer, share, or drive the decision. Three domains differentiated patients between groups: (1) overall disposition toward the surgeon, (2) tendency to exchange information and ask questions, and (3) attitudes toward how their preferences should shape the treatment decision. We identified surgeon behaviors that could optimize patient engagement. These opportunities were observed across all patients, regardless of their experience with the decision process. Surgeons can empower patients to engage in decision-making by getting to know patients as individuals, ensuring all treatment options are presented, and integrating patient preferences into the decision process. Through these actions, surgeons can help patients with varied preferences for decision-making engage in making high quality decisions that reflect patients' priorities. These suggestions may have the greatest impact on socially disadvantaged patients and help to reduce disparities in care.