Short summary

This study investigates current shared-decision making (SDM) practice and patient involvement during facial non-melanoma skin cancer (NMSC) multidisciplinary team conferences (MDTs). The patient partakes in an MDT hosted by the Department of Plastic Surgery with participation from the Depts. of Oncology and Ophthalmology at Vejle Hospital. The study aims to give an insight in patients' experiences with SDM and their involvement in the decision-making process. Furthermore, it addresses the physicians' capabilities of showing SDM behaviour during facial NMSC MDTs.

Rationale

Non-melanoma skin cancer (NMSC) is the most common type of cancer in Denmark, accounting for more than 14,000 cases annually, and the tumours are often located to the face or scalp. The diagnosis rates are increasing, probably due to lengthening life expectancies as well as increased attention towards the disease.

Typically, hospital treatments of NMSC are either surgical removal or radiation therapy, and the decision depends on the type and size of the tumour, cosmetic results, as well as probability of radical treatment.

At Vejle Hospital, the facial NMSC patient partakes in a multidisciplinary team conference (MDT) hosted by the Department of Plastic Surgery with participation from the Department of Oncology and, on some occasions, the Department of Ophthalmology. 

The key concept is that the clinicians are health and disease experts, whereas the patient is the expert of their own life. The patient needs support from the clinicians in order to decide on the right treatment in their individual case. A collaboration between the physicians providing a strong foundation of medical expertise and the patient providing their personal values and expectations results in a balanced decision-making process. This is called shared decision-making.

A recent national report concludes that patients generally desire to be involved in decisions pertaining to their own health in non-acute matters. Implementing shared-decision making in skin cancer care is, therefore, of great interests to clinicians at Vejle Hospital, but little is known regarding patients' experiences in the meeting with several doctors in a multidisciplinary team setup. We wish to elucidate facial NMSC patients' impressions of the MDT and, at the same time, uncover how they feel involved in the decision-making process of the MDTs when choosing the treatment regimen that is right for them. 

The investigations will be carried out through observations of consultations followed by semi-structured interviews with selected patients. Furthermore, we will conduct another observational study, which aims to determine clinicians' abilities of showing shared decision-making behaviour during facial NMSC MDTs.

Description of the cohort

Patients with facial non-melanoma skin cancer of both sexes were allowed to participate in the study. Furthermore, the following inclusion criteria had to be met:

- Referral to the facial NMSC MDT at Vejle Hospital

- >18 years of age

- Danish language speaker

- Resident in the Region of Southern Denmark

Data and biological material

This study consists of two sub-studies:

Observational studies of facial NMSC multidisciplinary team conferences followed by semi-structured interviews with the patients included in the above mentioned MDTs (sub-study #1).

Observational studies of clinicians' capabilities of showing shared decision-making behaviour during facial NMSC MDTs using the validated OPTION 12 tool (sub-study #2).

Furthermore, medical record data including any comorbidities, relatives taking part in the MDT, distance to hospital, age, and sex will be collected and undergo descriptive statistical analysis.

Collaborating researchers and departments

Department of Plastic Surgery, Vejle Hospital

• Medical student, Anna Skovsbo Vamdrup (RPM)
• MD, PhD, Vibeke Koudahl
• MD, Sofie Hody

Department of Health Research, Lillebaelt Hospital

• Professor, Regner Birkelund

Centre for Shared Decision-Making, Lillebaelt Hospital

• BscN, Karina Olling