Supportive Care in Cancer

, Volume 26, Issue 4, pp 1197–1205 | Cite as

Triadic treatment decision-making in advanced cancer: a pilot study of the roles and perceptions of patients, caregivers, and oncologists

  • Thomas W. LeBlanc
  • Nick Bloom
  • Steven P. Wolf
  • Sarah G. Lowman
  • Kathryn I. Pollak
  • Karen E. Steinhauser
  • Dan Ariely
  • James A. Tulsky
Original Article



The research on cancer treatment decision-making focuses on dyads; the full “triad” of patients, oncologists, and caregivers remains largely unstudied. We investigated how all members of this triad perceive and experience decisions related to treatment for advanced cancer.


At an academic cancer center, we enrolled adult patients with advanced gastrointestinal or hematological malignancies, their caregivers, and their oncologists. Triad members completed a semi-structured qualitative interview and a survey measuring decisional conflict and perceived influence of the other triad members on treatment decisions.


Seventeen patients, 14 caregivers, and 10 oncologists completed the study. Patients and caregivers reported little decisional regret and voiced high satisfaction with their decisions, but levels of decisional conflict were high. We found sizeable disagreement among triad members’ perceptions and preferences. For example, patients and oncologists disagreed about the caregiver’s influence on the decision 56% of the time. In addition, many patients and caregivers preferred to defer to their oncologist about treatment decisions, felt like no true decision existed, and disagreed with their oncologist about how many treatment options had been presented.


Patients, caregivers, and oncologists have discordant perceptions of the cancer treatment decision-making process, and bring different preferences about how they want to make decisions. These data suggest that oncologists should assess patients’ and caregivers’ decisional preferences, explicitly signal that a decision needs to be made whenever approaching an important crossroads in treatment and ensure that patients and caregivers understand the full range of presented options.


Advanced cancer Treatment decisions Triadic decision-making 


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Thomas W. LeBlanc
    • 1
    • 2
  • Nick Bloom
    • 3
  • Steven P. Wolf
    • 4
  • Sarah G. Lowman
    • 5
  • Kathryn I. Pollak
    • 1
    • 6
  • Karen E. Steinhauser
    • 7
    • 8
    • 9
  • Dan Ariely
    • 10
  • James A. Tulsky
    • 11
    • 12
  1. 1.Duke Cancer InstituteDurhamUSA
  2. 2.Division of Hematological Malignancies and Cellular Therapy, Department of MedicineDuke University School of MedicineDurhamUSA
  3. 3.Department of SociologyDuke UniversityDurhamUSA
  4. 4.Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamUSA
  5. 5.School of DentistryUniversity of North Carolina at Chapel HillChapel HillUSA
  6. 6.Department of Community and Family MedicineDuke University School of MedicineDurhamUSA
  7. 7.Center for Health Services Research in Primary Care, Durham VA Medical CenterDurhamUSA
  8. 8.Department of Medicine, Division of General Internal Medicine, Palliative Care SectionDuke University School of MedicineDurhamUSA
  9. 9.Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamUSA
  10. 10.James B. Duke Professor of Psychology and Behavioral EconomicsDuke UniversityDurhamUSA
  11. 11.Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA
  12. 12.Division of Palliative Medicine, Department of Medicine, Brigham and Women’s HospitalBostonUSA

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