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Decision-making in oncology: a selected literature review and some recommendations for the future

Ménard, Catherine; Merckaert, Isabelle; Razavi, Darius; Libert, Yves

doi: 10.1097/CCO.0b013e328354b2f6
SUPPORTIVE CARE: Edited by Jean Klastersky

Purpose of review Decision-making in oncology is associated with uncertainty and potential decisional conflict. The purpose of this paper is to review strategies suggested to improve treatment decision-making, discuss their limits and describe recommendations that have been made to improve the decision-making process.

Recent findings To improve the decision-making process, uncertainty reduction, shared decision-making and multidisciplinary teamwork have been initially proposed. Due to their limits, alternative approaches such as uncertainty management, collaborative decision-making and collaborative multidisciplinary teamwork have been recommended. Uncertainty management considers uncertainty as a multilevel concept. It may be achieved through collaborative decision-making and collaborative multidisciplinary teamwork. Collaborative decision-making is an in-depth personalized iterative assessment of patient medical, psychological and social status. It promotes the patient's proactive role as a key stakeholder of decision-making and the physician's proactive role as a key support to patient decision-making. Collaborative multidisciplinary teamwork promotes an optimal environment for collaborative decision-making in which patients are key stakeholders and all relevant healthcare professionals are actively involved. These approaches require developing interventions for patients, and trainings for physicians and multidisciplinary teams.

Summary On the basis of these recent approaches, we propose a ‘three-step model of multidisciplinary collaborative treatment decision-making’ in oncology. This model should be tested for its validity.

Jules Bordet Institute and Université Libre de Bruxelles, Psychosomatic and Psycho-Oncology Research Unit, Brussels, Belgium

Correspondence to Yves Libert, Jules Bordet Institute, 121 Boulevard de Waterloo, 1000, Brussels, Belgium. Tel: +32 2 541 34 15; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.