Treatment Decision Making and Its Discontents

Abstract

Patient participation in treatment decision making is held as a virtue in clinical contexts, and has much to recommend it. Yet important questions have been raised about the assumptions underlying models of patient participation. Debates have arisen about the significance of medically defined risks and outcomes of treatment; the adequacy and relevance across social groups of the concept of autonomy; and the emphasis on the professional–patient dyad. This article contributes to the debate about treatment decision making with reference to a study focused on older women with cancer. Interviews with patients and cancer care professionals highlighted the salience to patients' treatment choices of experiential knowledge, social roles and responsibilities, and the health policy context. It appears that prevailing models of decision making may obscure patients' more typical decision processes as well as the social determinants of those choices.

KEYWORDS:

• treatment decision making
• cancer care
• social context of health care
• Canada

We want to express our appreciation to the patients and health professionals who agreed to be interviewed for this project, and to members of the 70+ Women and Cancer Study Team: Ann Wray Hampson, Enid Small, Thelma McGillivray (Older Women's Network), Barb Daize and Pam Board (Breast Cancer Support Services), Wanda Risso, Jane Vock, and Donna Fitzpatrick-Lewis (Project Staff). Thanks are due as well to Pam Hudak, Ann Wray Hampson, Lisa Schwartz, and two reviewers for their thoughtful commentary on earlier versions of this article. This study is part of a research program entitled Intersecting Vulnerabilities: Gender, Poverty, Age & Aboriginal Identity in Women's Lived Experience of Breast & Gynecological Cancer, funded by the Canadian Institutes of Health Research. The study is also supported by a grant from McMaster University. The Canadian Breast Cancer Foundation, Ontario Chapter, funded the Ontario Breast Cancer Community Research Initiative, home of the Intersecting Vulnerabilities research program.