Shared Decision-Making Support Process for Healthcare Professionals for Pregnant Cancer Patients and Their Families

OBJECTIVE: The mean age of cancer diagnosis has decreased, while the mean age of first marriage and child delivery has increased in Japan in recent years. Accordingly, an increasing number of pregnant women are being diagnosed with cancer. Pregnant cancer patients must consider simultaneously receiving cancer treatment and continuing their pregnancy and make related decisions. Healthcare professionals (HCPs) who support patients and their families experience conflict over which care should be prioritized between that for the patient and that of the fetus. Supporting pregnant cancer patients and their families in such complicated situations is challenging. This study aimed to explore the process of support for continuing cancer treatment for, and pregnancy in, cancer patients, based on shared decision-making (SDM) between the patient, her family, and HCPs. METHODS: This was a qualitative, descriptive study carried out with six nurses, five clinicians, and three obstetricians with experience of providing decision-making support to a pregnant cancer patient and her family. Individual interviews and a focus group interview were conducted. RESULTS: We identified ten categories, of which the following five are integral to the process of providing support for pregnant cancer patients: “Preparing for SDM with the patient and her family;” “HCPs working in a team while clarifying their individual roles and responsibilities;” “confirming the intentions of the patient and her family in setting the orientation;” “improving the system for HCPs to provide support to the patient during cancer treatment,” and “providing the patient with support that helps her make informed decisions.” CONCLUSIONS: Decision-making support is provided to both the patient and her family, and HCPs work in teams to provide support. Moreover, HCPs continue to provide support to the patient and her family after a decision has been made.