Abstract
Aim
This research explores factors influencing treatment decision-making in cancer consultations with Māori patients and whānau (extended families) to ascertain if any of these factors could be contributing to cancer treatment inequities experienced by Māori.
Design
Māori centred research using case study and qualitative methods.
Participants
Five adult Māori patients who had recently received a cancer diagnosis participated in this study along with their whānau and three oncology specialists with whom they had a consultation where a treatment option was discussed.
Methods
Consultations were audio-recorded and soon after patients and whānau were interviewed. Specialists self-recorded a brief debrief using a prompt questionnaire.
Results
Within and across cases, a range of factors appeared to influence patients’/whānau treatment decision-making: comorbidity, disease and treatment factors. Whānau involvement and support was significant as was the specialist’s treatment recommendation. They also identified positive experiences with the specialist. Specialists attended the consultation prepared to offer one medical treatment option in each of the cases studied and patient factors such as fitness for treatment, family history and symptoms appeared important to their treatment decision-making. Information shared by specialists with patients indicated comorbidity, disease, treatment and health care system factors such as multidisciplinary team decision-making had influenced the development of the treatment option offered in the consultation.
Conclusion
This research provides valuable information about the range of factors that influence both specialists’ and patients’/whānau treatment decision-making in cancer consultations. Whānau and specialists treatment recommendations appeared important to patients’ decision-making and medical factors and patient factors to specialists’. In some cases, comorbidity requires greater attention given the impact it has on treatment decision-making.
While it did not appear as if any of these factors were likely contributors to cancer treatment inequities there were signs to suggest that health care system treatment decision-making processes could be improved. Further exploration for factors influencing treatment decision-making earlier in the treatment decision-making pathway may also provide clues to potential causes of treatment inequities.