# Implementation and Measurement of Shared Decision Making in Gynaecological Oncology Outpatient Setting at a Tertiary Cancer Centre

## TL;DR

This study tested a tool to improve doctor-patient collaboration in gynaecological cancer care, finding that doctors felt more effective in involving patients, though patient perceptions didn't change significantly.

## Contribution

The study introduces and evaluates the BRAN tool to enhance shared decision-making in gynaecological oncology outpatient settings.

## Key findings

- Physicians reported a statistically significant improvement in shared decision-making after using the BRAN tool.
- Staff observed increased patient involvement and improved consultation styles following the tool's implementation.
- No significant change in patient perceptions of shared decision-making was detected, possibly due to high baseline levels.

## Abstract

This study looked at how doctors and patients can work together to make treatment decisions, particularly in gynaecological cancer outpatient clinics. The study aimed to see whether introducing a simple tool, called BRAN, could improve these shared discussions in a clinic. The findings showed that doctors felt they were better at involving patients after using the tool, and staff noticed patients becoming more engaged in their care. This work highlights the importance of open communication in healthcare and offers insights for other medical fields looking to empower patients in their treatment choices, ultimately leading to greater patient satisfaction and quality of life.

Background: Shared Decision-Making (SDM) is important for patient-centred care, especially in areas such as gynaecological oncology where treatment decisions are often multifaceted. This study aimed to implement and measure SDM in a gynaecological oncology outpatient clinic, specifically assessing the impact of the BRAN (Benefits, Risks, Alternatives, Nothing) tool on patient and physician perceptions. Methods: A two-phased prospective observational and survey mixed-methodology study was conducted at the tertiary Northern Gynaecological Oncology Centre (NGOC) outpatient clinic in Gateshead, United Kingdom, from October 2023 to November 2024. SDM champions provided staff training. Patient and physician perspectives were measured using the nine-item Shared Decision Making Questionnaire (SDM-Q-9). Phase one was a baseline assessment; phase two involved the implementation of BRAN posters and leaflets. Statistical analyses included the Mann–Whitney U Test and Fisher’s Exact Test. A post-implementation online staff survey was conducted. Results: A total of 207 patients and 13 physicians participated: 107 patients and 13 physicians in phase one and 100 patients and 12 physicians in phase two. Whilst no statistically significant difference in patients’ perceptions of SDM was found between phases (p = 0.73), physicians’ perceptions showed a statistically significant improvement after BRAN tool implementation (p < 0.01). The staff survey results indicated that 84% observed increased patient involvement, and 92% agreed that SDM helped achieve consultation goals. Conclusions: The implementation of SDM at the NGOC led to a statistically significant improvement in the subjective use of SDM by physicians’, despite no significant change in patients’ perceptions, possibly due to high baseline levels. Staff reported increased patient engagement and improved consultation styles. These findings support implementing SDM in gynaecological oncology outpatient settings