Family involvement in treatment decision making for older patients with cancer
Family involvement in treatment decision making for older patients with cancer
This dissertation focuses on the role of family members in decision-making regarding the treatment of older patients with cancer. It examines how healthcare professionals, patients, and family members jointly shape shared decision-making, and how family relationships and dynamics influence this process.
A scoping review identified five categories that affect family involvement: patient characteristics, family member characteristics, family system properties, the role of the physician, and cultural factors. These elements determine the extent to which families influence treatment choices and how both patients and relatives experience the decision-making process.
Qualitative interviews with surgeons, nurses, and family members highlighted the proactive role of adult children, the impact of shared family values, and the importance of family dynamics. Family members take on various supportive roles, such as providing practical and informational assistance, emotional support, and, when necessary, acting as advocates. At the same time, they face dilemmas, including balancing their own opinions with the patient’s preferences, maintaining trust in healthcare professionals, and weighing caregiving responsibilities against personal needs.
Observational studies showed that patients generally participated more actively in shared decision-making than family members, but that physicians’ attitudes played a decisive role. Overall, professionals rarely involved family members explicitly, though they usually responded respectfully to their questions. Notably, family members of patients aged 80 years and older were more likely to participate (pro)actively, for example by asking questions or providing additional information about the patient.
In conclusion, family involvement proves to be both supportive and challenging. The findings underscore the importance of family-inclusive strategies that strengthen triadic decision-making while accounting for roles, dilemmas, and family dynamics.