Exploring family involvement in cancer consultations and decision-making

Introduction Family members (FM) often attend cancer consultations with patients and may be involved in medical decision-making (DM). However, limited research, theory, and practical strategies include the family. This thesis aimed to examine the existing evidence base, explore health professional (HP), patient, and family experiences of, and actual behaviours in cancer consultations involving family. It aimed to utilise this research to propose an initial conceptual framework and draft physician communication strategies. Method A systematic review of 52 triadic consultation studies was conducted. Interviews with 10 nurses, 11 oncologists, 30 patients, and 34 FMs examined their attitudes and experiences. An interaction analysis coding system capturing family-relevant behaviours was developed and applied to 72 audiotaped cancer consultations. An initial conceptual framework of triadic DM and communication strategies were developed. Results HPs, patients, and FMs held positive attitudes towards family involvement. However, challenges such as conflicting patient-family wishes were reported. HPs reported inclusive behaviours, however consultation analyses revealed HPs rarely initiated interaction with FMs and regularly interrupted them. In light of study results, practical strategies for HPs to manage and enhance family involvement were proposed. Additionally, triadic (physician-patient-family) DM may rest on a spectrum from passive to dominant, is variable and dynamic, and may be influenced by a number of clinical and contextual factors. An initial conceptual framework was proposed, using a triangle to graphically represent triadic dynamics. Conclusion This thesis improves our understanding of patient, FM, and HP experiences of, and actual behaviours in, cancer consultations and raises a number of conceptual, ethical, and practical issues regarding the accommodation of family. Continued refinement of the framework and strategies will follow completion of this thesis