Integrated oncological treatment decision-making: Creating a practice of patient-centred decision-making

Abstract

The growing burden of cancer, with its costly and difficult to endure therapies, underscores the urgent need for individualized care that enhances patients' quality of life. Effective individualized treatment planning requires collaboration between healthcare professionals and patients (and their relatives), focusing on patients' personal values and preferences through shared decision-making. In practice, oncology care predominantly follows clinical guidelines, which, while reducing practice variation, may not account for individual patient differences in health status and preferences. Moreover, guidelines often emphasize medical endpoints such as disease-free survival, overlooking quality of life and treatment burden considerations crucial to many patients. This can result in unfitting treatment choices and decisional regret. The Integrated Oncological Decision-making Model (IODM) addresses these challenges by incorporating three essential domains for treatment decision-making: medical treatment options, patient goals and preferences, and general health status. The IODM aims to integrate these domains into the decision-making process, ensuring that treatment plans are tailored to individual patient needs. Initial implementation of the IODM is shown promising results, with a significant proportion of patients receiving less invasive, more appropriate treatments without compromising survival outcomes. The IODM has demonstrated its potential to facilitate patient-centred care, reduce unnecessary treatments, and improve patient outcomes. Continued implementation and evaluation of the IODM across various oncological settings are essential to refine the model and ensure its integration into routine clinical practice, ultimately enhancing the quality and effectiveness of cancer care.