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Who decides? Shared decision-making among colorectal cancer surgery patients in China

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Abstract

Purpose

Patient-centered care (PCC) and shared decision-making (SDM) is advised within the English medical literature for its positive impact. The benefits of such approaches are said to foster increased trust, patient decision satisfaction, and even better outcomes. Looking at a Chinese cancer hospital, this research sought to understand how surgical decision-making was made among colorectal cancer patients.

Methods

Observations (n = 36) and semi-structured interviews (n = 24) were conducted with patients and family members.

Results

In the observations, 69.4% of the participating families made the decision to undergo surgery at the end of the consultation. In the interviews, three main themes emerged in regard to the characteristics in the family decision-making model, and they included three structural elements: the patient’s sick role, family functional structure, and control of information.

Conclusion

This study showed that the Chinese decision-making model is different from the western SDM model. In the Chinese context, family members dominated the decision-making process which raised concerns around informed consent. This may benefit patients insofar as receiving timely treatment in the short term but at the same time may be at the expense of limiting patient’s autonomy. The promotion of a new model or a model encompassing family-centered care values may be more appropriate in clinical practice in China that can address the issues around informed consent.

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Funding

This study was supported by the Major Program of the National Social Science Fund of China (Grant No. 18ZDA362): Research on the Physician-Patient Relationship in the Era of Big Data; and Guangzhou Concord’s Medical Humanities Research and Education Foundation (Grant No. 201920).

Author information

Authors and Affiliations

  1. Office of Research Management and Education Administration, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China

    Huiwen Zhai & Christopher Lavender

  2. School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, 510275, Guangdong, China

    Huiwen Zhai, Haotan Wu & Yu Cheng

  3. Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine , Guangzhou, 510060, Guangdong, China

    Cong Li

  4. School of Nursing, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China

    Ni Gong

  5. Department of Medical Humanities, the Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, 518107, Guangdong, China

    Yu Cheng

Authors
  1. Huiwen Zhai
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  2. Christopher Lavender
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  3. Cong Li
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  4. Haotan Wu
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  5. Ni Gong
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  6. Yu Cheng
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Contributions

HZ and YC participated in the design of the study. HZ, CL, and HW were involved in the data collection, analysis, and interpretation. HZ and CL wrote the manuscript. All authors were involved in the critical revision of the manuscript.

Corresponding author

Correspondence to Yu Cheng.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the Institutional Review Board (IRB) of the Department of Anthropology, Sun Yat-sen University (IORG0003827) in Guangzhou, China and was conducted in accordance with the 1964 Helsinki declaration and its later amendments.

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Zhai, H., Lavender, C., Li, C. et al. Who decides? Shared decision-making among colorectal cancer surgery patients in China. Support Care Cancer 28, 5353–5361 (2020). https://doi.org/10.1007/s00520-020-05391-3

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  • DOI: https://doi.org/10.1007/s00520-020-05391-3

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