Project details

Treatment decision-making in oncology is increasingly complex, as many treatment options with different benefit-harm profiles are available. These treatment choices present serious yet different impact on health outcomes and patients’ quality of life. Patients with cancer want to participate in treatment decisions. Medical guidelines and the German patients’ right act emphasize the right of informed shared decision-making (ISDM). ISDM is proposed as an interactive decision-making approach in which physicians and patients discuss all treatment options using evidence-based health information material, and incorporate patients’ individual preferences. Currently, ISDM is not implemented in routine care due to persistent barriers.

Interventions to facilitate ISDM and improve decision quality exist, and they include patient decision aids, question prompt sheets, and decision coaching. Decision coaching is a non-directive approach. Trained health care professionals provide decision support for patients who are making a health decision to prepare the subsequent physician consultations. The evidence about decision coaching is limited. Recent research has shown that nurse-led decision coaching demonstrated effectiveness with regard to patient participation and informed decision-making. However, the accompanying process evaluation identified various implementation barriers. While determinants of practice such as barriers, obstacles, facilitators and enablers of implementing ISDM have widely been described, determinants of practice of implementing decision coaching have not yet been systematically investigated. To overcome barriers and successfully implement future nurse-led decision coaching interventions, it will be crucial to consider determinants of practice right from the beginning of the intervention development. Therefore, and to build up on existing expertise in nurse-led decision coaching, an international collaboration between Birte Berger-Höger and her research group with Krystina Lewis, member of the Nursing School of the University of Ottawa, Ontario, Canada, the Ottawa Patient Decision Aid Group and the Centre for Research on Health and Nursing, Canada should be initiated. 

The main activity to establish the collaboration will be to plan a systematic review to identify determinants of practice for decision coaching.