Digital Technologies Supporting Shared Decision-Making in Oncology Consultations: Barriers, Enablers, and Recommendations for Improvement

Medical decision-making is complex, and patient involvement is crucial. Poor collaboration between patients and physicians can lead to misaligned treatments and dissatisfaction. Although shared decision-making is effective, it remains underutilised due to communication barriers. Many organisations claim to be paperless but still rely on printed documents, making it hard for clinicians to access important information. Paper-based processes fragment workflows, hinder communication, and frustrate patients. While digital tools for shared decision-making are promoted, evidence of their effectiveness is limited. Research Aim This research explored how technology can enhance shared decision-making in oncology consultations, identified barriers and enablers to the use of electronic health records, and proposed recommendations for improvement. Methodology Three studies were conducted: (1) a systematic review of digital tools for shared decision-making in medical oncology; (2) an ethnographic study on the use of these tools in outpatient clinics; and (3) human-centred co-design to develop a prototype for supporting cancer care decisions. Results Current technologies, including electronic health records, seldom facilitate shared decision-making in oncology. The research recommends adapting these technologies and utilising patient portals to improve collaboration while ensuring integration with oncologists’ workflows. Oncologists showed interest in innovations like generative AI, provided they can trust these tools. Conclusion There is significant potential for technology to enhance shared decision-making in oncology, and this thesis outlines a roadmap for improving digital platforms and creating new tools.