Strategies for involving family members in treatment decision making processes for older patients with cancer

Introduction: Many older patients with cancer have their family members, often their adult children, involved in a process of treatment decision making. Despite the growing awareness that family members can facilitate a process of shared decision making (SDM), literature about SDM pays little attention to family relations and strategies to facilitate family involvement in decision making processes.
Objective: This study aimed to 1. explore surgeons' and nurses' perceptions about involvement of adult children in treatment decision-making for older patients; and 2. identify strategies they use to ensure positive family involvement.
Methods: Semi-structured interviews were conducted with 13 surgical oncologists and 13 oncology nurses in two Dutch hospitals. Qualitative content analysis was conducted according to the steps of thematic analysis.
Results: Surgeons and nurses indicated that adult children's involvement in decision-making increases when patients become frail. They reported beneficial and challenging characteristics of this involvement. Six strategies to stimulate positive involvement of adult children in the decision-making process were revealed: 1. Focus on the patient; 2. Actively involve adult children; 3. Acknowledge different perspectives; 4. Get to know the family system; 5. Check that the patient and family members understand the information; and 6. Stimulate communication and deliberation with adult children.
Conclusion: Surgeons and nurses perceive involvement of adult in treatment decision making as beneficial. However, family involvement can trigger specific complexities and challenges in treatment decision conversations that call for practical patient and family-centered strategies.