Individual abstract within a Delegate Designed Symposium Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Bundled INtervention to improve Decision-making in advanced cancER (BINDER): Patient and clinician perspectives on decision coaching to support shared decision-making (142510)

Samuel X Stevens 1 2 , Kristin Wright 1 , Brooke E Wilson 1 , Christopher M Booth 1 , Natalie J Stevens 1 , Brian Shkabari 1 , Michael Sanatani 3 , Joseph C Del Paggio 4 , Scott R Berry 5 , Haryana M Dhillon 6
  1. Departments of Oncology and Medicine, Queen's University, Kingston, Ontario, Canada
  2. Department of Medical Oncology, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
  3. Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  4. Department of Oncology, Northern Ontario School of Medicine,, Thunder Bay, Ontario, Canada
  5. Carlo Fidani Peel Regional Cancer Centre, University of Toronto, Toronto, Ontario, Canada
  6. Faculty of Science, School of Psychology , The University of Sydney, Sydney, New South Wales, Australia

Aims: Shared decision-making (SDM) in advanced cancer is challenged by prognostic uncertainty, existential distress, and competing treatment priorities, contributing to care that may not align with patients’ goals.1-3 Decision support tools largely focus on curative settings.4 We sought to understand how patients and clinicians experience complex treatment decision-making in advanced cancer, and whether a bundled decision coaching (DC) intervention could support shared decision-making.

Methods: Semi-structured interviews were undertaken with purposively sampled patients with estimated prognosis under 12 months, medical oncologists, nurses, and nurse practitioners from four Canadian cancer centres. Interviews explored experiences of SDM, perceptions of decision satisfaction, and perceived barriers, enablers and acceptability of the intervention. Interviews were analysed using thematic analysis.

Results: Participants included 14 patients (86% Anglophone, 50% female, 43% 55-64 years old, 35% colorectal cancer) and 19 clinicians (73% female, 58% medical oncologists, median 7 years practising). We developed a conceptual model of SDM comprising five themes, with reactions to the intervention captured separately.  Participants described an ideal mental model of SDM (Theme 1), shaped by patient, clinician, and health system factors (‘Constraints’, Theme 2), resulting in the realities of “actual” decision-making (Theme 3). Limited consultation time, inadequate resources for emotional and decision-making support, and diminished patient agency emerged as key challenges. Participants described strategies to overcome barriers (Theme 4), including expanding the decision-space through iterative consultations, as well as providing tailored informational support. Decisions had emotional and moral consequences for patients and clinicians (Theme 5). The proposed intervention was viewed favourably as a means of complementing oncology consultations, clarifying patient values, mediating potential conflict, supporting emotional needs, and improving decision self-efficacy.

Conclusions: SDM in advanced cancer is constrained by interacting patient-, clinician- and system-level factors. These findings provide a theory-informed foundation for a bundled DC intervention designed to improve goal-concordant care in advanced cancer.

  1. Rodenbach, R. A. et al. Relationships Between Advanced Cancer Patients' Worry About Dying and Illness Understanding, Treatment Preferences, and Advance Care Planning. Journal of Pain and Symptom Management 61, 723-731.e721, doi:https://doi.org/10.1016/j.jpainsymman.2020.09.004 (2021).
  2. Gramling, R. et al. Determinants of Patient-Oncologist Prognostic Discordance in Advanced Cancer. JAMA Oncol 2, 1421-1426, doi:10.1001/jamaoncol.2016.1861 (2016).
  3. Mathews, J. et al. Measuring prognostic awareness in patients with advanced cancer: a scoping review and interpretive synthesis of the impact of hope. J Natl Cancer Inst 116, 506-517, doi:10.1093/jnci/djad267 (2024).
  4. George, L. S. et al. Palliative Chemotherapy or Radiation and Prognostic Understanding among Advanced Cancer Patients: The Role of Perceived Treatment Intent. J Palliat Med 23, 33-39, doi:10.1089/jpm.2018.0651 (2020).