How doctors present treatment options in advanced lung cancer consultations: a conversation analytic study

BACKGROUND: To facilitate shared decision-making (SDM), it is important that doctors clearly present the decision to be made and the available treatment options to the patient. This study explored how treatment options after first-line therapy were presented in advanced lung cancer consultations. METHODS: Audio recordings of 12 advanced lung cancer consultations between patients, their companions and doctors in three Norwegian hospitals were transcribed and analysed using Conversation Analysis. Data were collected between November 2019 and March 2022. RESULTS: Doctors employed three strategies when presenting treatment options to patients. These were (1) open option presentation, (2) selective option presentation and (3) recommended option presentation. Strategy (1) involved the doctor presenting all the possible treatment options in a balanced manner to the patient. With strategy (2), the doctor presented selected treatment options to the patient, and, for example, did not articulate the possibility of refraining from further therapy. Strategy (3) included the doctor's explicit preference for certain treatment options. CONCLUSIONS: Strategies that doctors employ to present treatment options to patients facilitated SDM to different degrees, where some can challenge core principles of SDM, such as creating choice awareness. Doctors must be aware of their strategies to ensure that treatment options are presented to patients in a way that supports SDM.