Bras Iris J M, Joosen Margot C W, Rutten Geert-Jan M, van Vugt Ingrid J M, Sitskoorn Margriet M, Boele Florien W, Hoogendoorn Petra, Gehring Karin
Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
Department of Cognitive Neuropsychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
Neurooncol Pract. 2024 Nov 6;12(2):219-230. doi: 10.1093/nop/npae110. eCollection 2025 Apr.
Patients with brain tumors, family members, and healthcare professionals face complex healthcare decisions that can significantly impact everyday life. Engaging in shared decision-making (SDM) can help ensure treatment decisions align with patients' preferences and goals. Little is known about the decision-making process in neurosurgical consultations. This study aims to qualitatively explore and describe the SDM process during neurosurgical consultations for patients with a presumed brain tumor.
The first consultation between patients with presumed glioma or meningioma and their neurosurgeons was audio-recorded and transcribed. Decision-making models were used as sensitization concepts, with coding carried out inductively. We employed a reflexive thematic analysis to develop themes and subthemes until saturation was beginning to emerge.
Analyzing eleven consultations, we developed three main themes and twelve subthemes. The results depict decision-making guided by neurosurgeons (theme 1), with varying degrees of engagement from patients and family members (theme 2) and personalization of the decision-making process based on the medical situation and everyday life priorities (theme 3). The consultations lacked specific attention to the everyday life priorities of the patients.
The decision-making processes seemed to focus primarily on medically informing patients with a presumed brain tumor, in line with informed decision-making. However, less emphasis was placed on learning more about the patient's everyday life and preferences to integrate into the decision-making process, which is key to SDM. Incorporating patient goals may lead to greater personalization and decisions that align with both the patient's medical situation and their goals.
脑肿瘤患者、家庭成员及医疗保健专业人员面临着复杂的医疗决策，这些决策会对日常生活产生重大影响。参与共同决策（SDM）有助于确保治疗决策符合患者的偏好和目标。目前对于神经外科会诊中的决策过程知之甚少。本研究旨在定性探索和描述疑似脑肿瘤患者神经外科会诊期间的共同决策过程。
对疑似胶质瘤或脑膜瘤患者与其神经外科医生的首次会诊进行录音和转录。将决策模型用作敏感化概念，进行归纳编码。我们采用反思性主题分析来形成主题和子主题，直至开始出现饱和状态。
通过分析11次会诊，我们形成了三个主要主题和十二个子主题。结果描绘了由神经外科医生主导的决策（主题1），患者和家庭成员的参与程度各不相同（主题2），以及基于医疗状况和日常生活优先级的决策过程个性化（主题3）。会诊中缺乏对患者日常生活优先级的具体关注。
决策过程似乎主要侧重于向疑似脑肿瘤患者提供医疗信息，这符合知情决策。然而，较少强调更多地了解患者的日常生活和偏好以纳入决策过程，而这是共同决策的关键。纳入患者目标可能会带来更大程度的个性化，并做出既符合患者医疗状况又符合其目标的决策。
